Local therapy for breast cancer in malignant lymphoma survivors.
OBJECTIVE
Breast cancer is the most frequent secondary tumor in young women previously treated with mantle radiation for Hodgkin's disease. Prior therapeutic radiation to the breast region is considered an absolute contraindication to breast conservative surgery, and mastectomy is considered the treatment of choice. We performed a retrospective review to assess the potential of performing breast conservative surgery and intraoperative radiotherapy with electrons (ELIOT), in these patients.


RESULTS
Forty-three patients affected by early breast cancer, previously treated with mantle radiation for malignant lymphoma, who underwent breast conservative surgery and ELIOT, were identified in our institution. Median age at diagnosis of lymphoma was 26 years (49% were less than 25). Median interval between lymphoma and breast cancer occurrence was 19 years. A total dose of 21 Gy (prescribed at 90% isodose) in 39 patients (91%), of 17 Gy (prescribed at 100% isodose) in 1 patient and 18 Gy (prescribed at 90% isodose), was delivered. ELIOT was well tolerated in all patients without any unusual acute or late reactions. After a median follow-up of 52 months, local recurrence occurred in 9% of the patients and metastases in 7% patients.


CONCLUSIONS
In patients previously treated for lymphoma, partial breast irradiation, and in particular ELIOT, permits breast conservative surgery without acute local complications, decreasing the number of avoidable mastectomies.
Division of Breast Surgery, European Institute of Oncology, Milan, Italy. mattia.intra@ieo.it
Mattia
M
Intra
Denise
D
Mattar
Claudia
C
Sangalli
Nicole
N
Rotmensz
Giuseppe
G
Viale
Viviana
V
Galimberti
Alberto
A
Luini
Paolo
P
Veronesi
Marco
M
Colleoni
Stefano
S
Zurrida
Roberto
R
Orecchia
Umberto
U
Veronesi
D000293:Adolescent; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D015331:Cohort Studies; D004307:Dose-Response Relationship, Radiation; D004583:Electrons / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008223:Lymphoma / Q000473:pathology / Q000532:radiotherapy; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D017741:Survivors; D016896:Treatment Outcome; D055815:Young Adult