title: Reirradiation and hyperthermia for irresectable locoregional recurrent breast cancer in previously irradiated area: Size matters.
abstract: OBJECTIVE
  Treatment options for irresectable locoregional recurrent breast cancer in previously irradiated area are limited. Hyperthermia, elevating tumor temperature to 40-45°C, sensitizes radio-and-chemotherapy. Four hundred and fourteen patients treated with reirradiation+hyperthermia (reRT+HT) in the AMC(n=301) and the BVI(n=113), from 1982 to 2005 were retrospectively analyzed for treatment response, locoregional control (LC) and prognostic factors for LC and toxicity.
  
  
  METHODS
  All patients received previous irradiation (median 50 Gy). reRT consisted of 8 × 4 Gy-2/week (AMC) or 12 × 3 Gy-4/week (BVI). Hyperthermia was added once (AMC)/twice (BVI) a week.
  
  
  RESULTS
  Overall clinical response rate was 86%. The 3-year LC rate was 25%. The number of recurrence episodes, distant metastases (DM), tumor site, tumor size, time to recurrence and treatment year were significant for LC. Acute ⩾ grade 3 toxicity occurred in 24% of patients. Actuarial late ⩾ grade 3 toxicity was 23% at 3-years. In multivariable analysis reRT fraction dose was significantly related to late ⩾ grade 3 toxicity.
  
  
  CONCLUSIONS
  reRT+HT is an effective curative and palliative treatment option for patients with irresectable locoregional recurrent breast cancer in previously irradiated area. Early referral, treatment of chest wall recurrences ⩽ 5 cm in the absence of distant metastases, provided the highest local control rates. The cumulative effects of past and present treatments should be accounted for by adjusting treatment protocol to minimize toxicity.
authors.affiliation: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands. Electronic address: s.oldenborg@amc.uva.nl.
authors.forename: Sabine
authors.initials: S
authors.lastname: Oldenborg
authors.affiliation: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Griesdoorn
authors.affiliation: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: van Os
authors.affiliation: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands.
authors.forename: Yoka H
authors.initials: YH
authors.lastname: Kusumanto
authors.affiliation: Department of Radiation Oncology, Institute Verbeeten (BVI), Tilburg, The Netherlands.
authors.forename: Bing S
authors.initials: BS
authors.lastname: Oei
authors.affiliation: Department of Radiation Oncology, Institute Verbeeten (BVI), Tilburg, The Netherlands.
authors.forename: Jack L
authors.initials: JL
authors.lastname: Venselaar
authors.affiliation: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Zum Vörde Sive Vörding
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Martijn W
authors.initials: MW
authors.lastname: Heymans
authors.affiliation: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands.
authors.forename: Merel Willemijn
authors.initials: MW
authors.lastname: Kolff
authors.affiliation: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands.
authors.forename: Coen R N
authors.initials: CR
authors.lastname: Rasch
authors.affiliation: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Crezee
authors.affiliation: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands.
authors.forename: Geertjan
authors.initials: G
authors.lastname: van Tienhoven
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D010349:Patient Compliance; D000069475:Re-Irradiation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D035441:Thoracic Wall / Q000528:radiation effects; D055815:Young Adult
keywords: Hyperthermia; Recurrent breast cancer; Reirradiation