[Second breast-conserving surgery and reirradiation with interstitial high-dose-rate brachytherapy for the management of intra-breast recurrences -- 5-year results].
The purpose of our work was to evaluate the efficacy of second breast-conserving surgery (BCS) and reirradiation with interstitial high-dose-rate (HDR) brachytherapy (BT) for the management of local recurrences. Between 1999 and 2010, fifteen patients initially treated for breast carcinoma by BCS and radiation therapy who had isolated intra-breast recurrence underwent second BCS and perioperative HDR multicatheter BT. Breast cancer related events, late side effects, and cosmetic results were assessed. At a median follow-up of 62 months (range: 11-127) second local recurrence has not occurred, yielding a 100% mastectomy-free survival. Four patients (27%) developed subsequent distant metastasis and died of breast cancer. The 5-year actuarial rate of disease-free and overall survival was 69% and 85%, respectively. Cosmetic results were rated excellent, good, fair, poor, and unknown in 1 (7%), 10 (66%), 2 (13%), 1 (7%), and 1 (7%) patients, respectively. Grade 2 fibrosis and skin toxicity occurred in 1 (7%) and 1 (7%) patients. Asymptomatic fat necrosis was detected in 9 (60%) women. No patient developed grade 3-4 late side effects. Second BCS followed by partial breast reirradiation is a safe and effective option for the management of selected patients developing intra-breast recurrence after previous breast-conserving therapy. Perioperative HDR BT may decrease the risk of second local relapse with acceptable cosmetic results and low rate of late side effects.
Sugárterápiás Osztály, Országos Onkológiai Intézet, Budapest, Hungary. polgar@oncol.hu
Csaba
C
Polgár
Tibor
T
Major
Zoltán
Z
Sulyok
Georgina
G
Fröhlich
Eva
E
Szabó
Akos
A
Sávolt
Zoltán
Z
Mátrai
László
L
Tóth
János
J
Fodor
D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy / Q000601:surgery; D018275:Carcinoma, Lobular / Q000532:radiotherapy / Q000601:surgery; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery*; D018365:Neoplasm, Residual / Q000175:diagnosis; D017060:Patient Satisfaction; D017785:Photons / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome