title: Long-term followup of breast preservation by re-excision and balloon brachytherapy after ipsilateral breast tumor recurrence.
abstract: OBJECTIVE
  To report our long-term experience with balloon brachytherapy in retreatment of the breast after ipsilateral breast tumor recurrence.
  
  
  METHODS
  Between March 2004 and June 2012, 18 patients previously treated with external beam radiotherapy were retreated using either the MammoSite (Hologic Corporation, Marlborough, MA), MammoSite ML (Hologic Corporation), or the Contura (Bard Peripheral Vascular, Inc., Tempe, AZ) brachytherapy devices. Sixteen patients were treated for an ipsilateral breast tumor recurrence after breast conservation surgery and postoperative irradiation (11 with infiltrating ductal carcinoma [IDC] and 6 with ductal carcinoma in situ [DCIS]), whereas 2 patients developed an in-field breast cancer likely associated with Hodgkin disease mantle irradiation (27 and 17 years prior, respectively). The recurrent histology of seven was IDC, with seven others recurring as DCIS, three as a combination of IDC/DCIS, and one as infiltrating lobular carcinoma. All patients received a twice-daily tumor dose of 3400 cGy at 340 cGy per fraction. Acute and chronic side effects were graded by the Common Terminology Criteria for Adverse Events, version 4.0. Cosmesis was graded by both the Harvard Cosmesis Scale and the Allegheny General Modification of the Harvard Scale.
  
  
  RESULTS
  With a mean of followup of 39.6 months, only 2 patients developed a local recurrence. One patient developed an inflammatory recurrence from what was identified as a moderately differentiated T1N0M0 estrogen receptor-positive recurrence, and the second developed a recurrence immediately adjacent to the implant site. Both patients were treated locally by salvage mastectomy. The patient who developed an inflammatory recurrence rapidly developed visceral metastases including brain lesions and succumbed to her progressive disease. The second patient was successfully salvaged with uncomplicated mastectomy, and she survives to this date. One patient developed a chronic abscess in the sinus tract of the balloon, which required mastectomy, and one developed a post-treatment infection in the catheter tract, which was successfully treated with oral antibiotics. Cosmesis as graded by the Harvard cosmesis criteria and the Allegheny General Modification Score diminished one grade in only 2 patients. All other patients had stable cosmetic scores.
  
  
  CONCLUSIONS
  Use of balloon brachytherapy devices in the treatment of the previously irradiated breast is feasible and may provide adequate local control and acceptable cosmesis in carefully selected patients. Further study and refinement of this therapy is required for more definitive results.
authors.affiliation: Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA; Department of Radiation Oncology, Temple University School of Medicine, Pittsburgh Campus, Pittsburgh, PA. Electronic address: mtrombet@wpahs.org.
authors.forename: Mark
authors.initials: M
authors.lastname: Trombetta
authors.affiliation: Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hall
authors.affiliation: Department of Surgery, Allegheny General Hospital, Pittsburgh, PA; Department of Surgery, Temple University School of Medicine, Pittsburgh Campus, Pittsburgh, PA.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Julian
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000532:radiotherapy* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D016879:Salvage Therapy; D016896:Treatment Outcome
keywords: Balloon; Brachytherapy; Breast cancer; HDR; Radiation; Retreatment