title: [Second conservative radiosurgical treatment for ipsilateral breast cancer recurrence].
abstract: OBJECTIVE
  Currently, radical mastectomy represents the gold standard for ipsilateral breast cancer recurrence. However, we already showed that a second conservative treatment was feasible combining lumpectomy plus low-dose rate interstitial brachytherapy. In this study, we reported the preliminary results of a second conservative treatment using a high-dose rate brachytherapy.
  
  
  METHODS
  From June 2005 to July 2009, 42 patients presenting with an ipsilateral breast cancer recurrence underwent a second conservative treatment. Plastic tubes were implanted intra-operatively at the time of the lumpectomy. After a post-implant CT scan, a total dose of 34 Gy in 10 fractions over 5 consecutive days was delivered through an ambulatory procedure. The toxicity evaluation used the Common Terminology Criteria for Adverse Events v3.0.
  
  
  RESULTS
  The median follow-up was 21 months (6-50 months), median age at the time of the local recurrence was 65 years (30-85 years). The median delay between the primary and the recurrence was 11 years (1-35 years). The location of the recurrence was in the tumor bed for 22 patients (52.4%), in the same quadrant for 14 patients (33.3%) and unknown for six patients (14.3%). The median tumor size of the recurrence was 12 mm (2-30 mm). The median number of plastic tubes and plans were nine (5-12) and two (1-3) respectively. The median CTV was 68 cm(3) (31.2-146 cm(3)). The rate of second local control was 97%. Twenty-two patients (60%) experienced complications. The most frequent side effect consisted in cutaneous and sub-cutaneous fibrosis (72% of all the observed complications).
  
  
  CONCLUSIONS
  A second conservative treatment for ipsilateral breast cancer recurrence using high-dose rate brachytherapy appears feasible leading to encouraging results in terms of second local control with an acceptable toxicity. Considering that a non-inferiority randomized trial comparing mastectomy versus second conservative treatment could be difficult to perform, what proof level will be necessary to achieve in order to change the medical procedures?
authors.affiliation: Département de Radiothérapie Oncologique, Centre Antoine-Lacassagne, 33 Avenue de Valombrose, 06189 Nice cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Castelli
authors.forename: A
authors.initials: A
authors.lastname: Figl
authors.forename: I
authors.initials: I
authors.lastname: Raoust
authors.forename: M
authors.initials: M
authors.lastname: Lallement
authors.forename: B
authors.initials: B
authors.lastname: Flipo
authors.forename: F
authors.initials: F
authors.lastname: Ettore
authors.forename: C
authors.initials: C
authors.lastname: Chapelier
authors.forename: J-M
authors.initials: JM
authors.lastname: Ferrero
authors.forename: A
authors.initials: A
authors.lastname: Courdi
authors.forename: J-M
authors.initials: JM
authors.lastname: Hannoun-Lévi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011859:Radiography; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D047368:Tumor Burden