Elective re-irradiation and hyperthermia following resection of persistent locoregional recurrent breast cancer: A retrospective study.
OBJECTIVE
To analyse the therapeutic effect and toxicity of re-irradiation (re-RT) combined with hyperthermia (HT) following resection or clinically complete remission (CR) of persistent locoregional recurrent breast cancer in previously irradiated area.


METHODS
Between 1988 and 2001, 78 patients with high risk recurrent breast cancer underwent elective re-RT and HT. All patients received extensive previous treatments, including surgery and high-dose irradiation (> or =50Gy). Most had received one or more lines of systemic therapy; 44% had been treated for > or = one previous locoregional recurrences. At start of re-RT + HT there was no macroscopically detectable tumour following surgery (96%) or chemotherapy (CT). Re-RT typically consisted of eight fractions of 4Gy, given twice weekly. Hyperthermia was added once a week.


RESULTS
After a median follow up of 64.2 months, three-year survival was 66%. Three- and five-year local control rates were 78% and 65%. Acute grade 3 toxicity occurred in 32% of patients. The risk of late > or = grade 3 toxicity was 40% after three years. Time interval to the current recurrence was found to be most predictive for local control in univariate and multivariate analysis. The extensiveness of current surgery was the most relevant treatment related factor associated with toxicity.


CONCLUSIONS
For patients experiencing local recurrence in a previously radiated area, re-irradiation plus hyperthermia following minimisation of tumour burden leads to a high rate of local control, albeit with significant toxicity. The latter might be reduced by a more fractionated re-RT schedule.
Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, The Netherlands. s.oldenborg@amc.uva.nl
Sabine
S
Oldenborg
Rob M
RM
Van Os
Caroline M
CM
Van rij
Johannes
J
Crezee
Jeroen B
JB
Van de Kamer
Emiel J T
EJ
Rutgers
Elisabeth D
ED
Geijsen
Paul J
PJ
Zum vörde sive vörding
Caro C E
CC
Koning
Geertjan
G
Van tienhoven
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate