title: Durable palliation of breast cancer chest wall recurrence with radiation therapy, hyperthermia, and chemotherapy.
abstract: OBJECTIVE
  Chest wall recurrences of breast cancer are a therapeutic challenge and durable local control is difficult to achieve. Our objective was to determine the local progression free survival (LPFS) and toxicity of thermochemoradiotherapy (ThChRT) for chest wall recurrence.
  
  
  METHODS
  Twenty-seven patients received ThChRT for chest wall failure from 2/1995 to 6/2007 and make up this retrospective series. All received concurrent superficial hyperthermia twice weekly (median 8 sessions), chemotherapy (capecitabine in 21, vinorelbine in 2, and paclitaxel in 4), and radiation (median 45 Gy). Patients were followed up every 1.5-3 months and responses were graded with RECIST criteria and toxicities with the NCI CTC v4.0.
  
  
  RESULTS
  Twenty-three (85%) patients were previously irradiated (median 60.4 Gy) and 22 (81%) patients received prior chemotherapy. Median follow-up was 11 months. Complete response (CR) was achieved in 16/20 (80%) of patients with follow-up data, and 1 year LPFS was 76%. Overall survival was 23 months for patients with CR, and 5.4 months in patients achieving a partial response (PR) (p=0.01). Twenty-two patients experienced acute grade 1/2 treatment related toxicities, primarily moist desquamation. Two patients experienced 3rd degree burns; all resolved with conservative measures.
  
  
  CONCLUSIONS
  ThChRT offers durable palliation and prolonged LPFS with tolerable acute toxicity, especially if CR is achieved.
authors.affiliation: Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Zagar
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Higgins
authors.forename: Edward F
authors.initials: EF
authors.lastname: Miles
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Vujaskovic
authors.forename: Mark W
authors.initials: MW
authors.lastname: Dewhirst
authors.forename: Robert W
authors.initials: RW
authors.lastname: Clough
authors.forename: Leonard R
authors.initials: LR
authors.lastname: Prosnitz
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D010166:Palliative Care; D013899:Thoracic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D035441:Thoracic Wall