title: Hyperthermia and radiation therapy for locally advanced or recurrent breast cancer.
abstract: BACKGROUND
  This study aims to report the outcome and toxicity of combined hyperthermia (HT) and radiation therapy (RT) in treatment of locally advanced or loco-regionally recurrent breast cancer.
  
  
  METHODS
  Patients treated with HT and RT from January 1991 to December 2007 were reviewed. RT doses for previously irradiated patients were > 40 Gy and for RT naïve patients > 60 Gy, at 1.8-2 Gy/day. HT was planned for 2 sessions/week, immediately after RT, for a minimum of 20 min and for > 4 sessions. Superficial or interstitial applicators were used with temperature measured by superficial or interstitial thermistors based on target thickness. HT treatment was assessed by thermal equivalent dose (TED), > 42.5 °C and > 43 °C. Endpoints included treatment response, lack of local progression (local control), and survival.
  
  
  RESULTS
  127 patients received HT and RT to 167 sites. These included the intact breast (24.4%), chest wall/skin (67.7%), and breast/chest wall and nodes (7.9%). At a median follow-up of 13 months (mean 30 ± 38), improved overall survival was significantly associated with increasing RT dose (p < 0.0001), median TED 42.5 °C ≥ 200 min (p = 0.003), and local control (p = 0.0002). Local control at last follow-up was seen in 55.1% of patients. Complete response was significantly associated with median TED 42.5 °C ≥ 200 min (p = 0.002) and median TED 43 °C ≥ 100 min (p = 0.03).
  
  
  CONCLUSIONS
  HT and RT are effective for locally advanced or recurrent breast cancer in patients that have been historically difficult to treat by RT alone. Over 50% of patients achieved control of locoregional disease. Overall survival was improved with local control.
authors.affiliation: Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, United States; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt; Northwestern Medicine Developmental Therapeutics Institute (NMDTI), Chicago, IL, United States.
authors.forename: Tamer
authors.initials: T
authors.lastname: Refaat
authors.affiliation: Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, United States.
authors.forename: Sean
authors.initials: S
authors.lastname: Sachdev
authors.affiliation: Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, United States.
authors.forename: Vythialinga
authors.initials: V
authors.lastname: Sathiaseelan
authors.affiliation: Department of Preventive Medicine, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, United States.
authors.forename: Irene
authors.initials: I
authors.lastname: Helenowski
authors.affiliation: Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Salah
authors.initials: S
authors.lastname: Abdelmoneim
authors.affiliation: Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, United States.
authors.forename: Margaret C
authors.initials: MC
authors.lastname: Pierce
authors.affiliation: Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, United States.
authors.forename: Gayle
authors.initials: G
authors.lastname: Woloschak
authors.affiliation: Department of Radiation Oncology, Stritch School of Medicine, Loyola University, Cardinal Bernardin Cancer Center, Chicago, IL, United States.
authors.forename: William
authors.initials: W
authors.lastname: Small
authors.affiliation: Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, United States.
authors.forename: Bharat
authors.initials: B
authors.lastname: Mittal
authors.affiliation: Department of Radiation Oncology, Rush University, Chicago, IL, United States. Electronic address: Krystyna_Kiel@rush.edu.
authors.forename: Krystyna D
authors.initials: KD
authors.lastname: Kiel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects / Q000706:statistics & numerical data; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Breast cancer; Hyperthermia; Locally advanced; Locoregional recurrence; Radiation therapy; Reirradiation