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Local recurrence of breast cancer: conventionally fractionated partial external beam re-irradiation with curative intention

Das lokal begrenzte Brustkrebsrezidiv: konventionell fraktionierte partielle perkutane Rebestrahlung in kurativer Intention

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Abstract

Purpose

To assess the outcome of breast cancer patients with local recurrence who underwent partial external beam re-irradiation (re-RT) either as part of a second breast-conserving therapy or following mastectomy.

Methods

Between 03/2004 and 10/2016, 83 breast cancer patients with local recurrence were treated with surgery followed by re-RT. The re-RT schedules were 45 Gy (1.8 Gy per fraction) administered either to the partial breast (n = 42) or mastectomy scar (n = 41). The patients and tumor characteristics predictive of local control, distant control, and survival (overall and breast-cancer specific) were evaluated by univariate and multivariate analyses.

Results

The median follow-up was 35 months (range 3–143 months). The median time interval between the first irradiation and re-RT was 117 months (range 16–357 months). The prognostic factors for favorable overall survival rates were younger age (p = 0.045), lower T‑category (p = 0.019), and N0 category (p = 0.005). N0 was also superior to N+ with respect to outfield recurrences (p = <0.001) and breast cancer-specific survival (p = 0.025). Acute and late skin toxicity was generally low (<grade 3).

Conclusion

Re-RT with 45 Gy (1.8 Gy per fraction) for partial breast or mastectomy scar after the second surgery resulted in high local control rates and tolerable skin toxicity.

Zusammenfassung

Zielsetzung

Das onkologische Ergebnis nach partieller perkutaner Rebestrahlung (Re-RT) bei Brustkrebspatientinnen mit einem Lokalrezidiv nach Mastektomie und/oder nach brusterhaltender Operation zu untersuchen.

Methoden

Zwischen 03/2004 und 10/2016 erhielten 83 Patienten postoperativ nach einem Lokalrezidiv des Mammakarzinoms eine perkutane Re-RT. Die Dosierung war 45 Gy (1,8-Gy-Einzeldosis) partiell auf die Brust (n = 42) oder auf die Mastektomienarbe (n = 41). Die Patienten- und Tumorcharakteristika wurden univariat und multivariat hinsichtlich lokaler und distanter Kontrolle, als auch auf das Überleben (gesamt- und karzinomspezifisch) untersucht.

Ergebnisse

Die mediane Nachbeobachtungszeit betrug 35 Monate (Spanne 3–143 Monate). Das mediane Intervall zwischen erster Bestrahlung und Re-RT war 117 Monate (Spanne 16–357 Monate). Prognostisch günstig für das Gesamtüberleben waren jüngeres Alter (p = 0,045), kleiner Rezidivtumor (p = 0,019) und kein Lymphknotenbefall (p = 0,005). Patientinnen mit N0-Status hatten im Vergleich zu N+-Patientinnen weniger Rezidive außerhalb des Bestrahlungsfelds (p = <0,001) und ein besseres brustkrebsspezifisches Überleben (p = 0,025). Grundsätzlich traten überwiegend leichte und moderate (<Grad 3) akute und chronische Hautveränderungen auf.

Schlussfolgerung

Die Re-RT mit 45 Gy nach Mastektomie oder brusterhaltender Operation erzielte ein gutes onkologisches Outcome und war zudem gut verträglich.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Luebeck, Luebeck, Germany

    S. Janssen & D. Rades

  2. Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany

    I. Wildfang

  3. Department of Radiotherapy and Special Oncology, Hannover Medical School, Hannover, Germany

    A. Meier, H. Christiansen & C. Henkenberens

  4. Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nuernberg, Nuremberg, Germany

    F. B. Fahlbusch

  5. Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA

    S. Schild

  6. Medical Practice for Radiotherapy and Radiation Oncology, Hildesheim, Germany

    A. Meyer

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  1. S. Janssen
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Correspondence to C. Henkenberens.

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Conflict of interest

S. Janssen, D. Rades, A. Meyer, F. B. Fahlbusch, I. Wildfang, A. Meier, S. Schild, H. Christiansen and C. Henkenberens declare that they have no competing interests.

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Janssen, S., Rades, D., Meyer, A. et al. Local recurrence of breast cancer: conventionally fractionated partial external beam re-irradiation with curative intention. Strahlenther Onkol 194, 806–814 (2018). https://doi.org/10.1007/s00066-018-1315-1

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