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Re-irradiation of the chest wall for local breast cancer recurrence

Results of salvage brachytherapy with hyperthermia

Re-Bestrahlung der Brustwand bei lokalen Brustkrebsrezidiven

Ergebnisse der Salvage-Brachytherapie mit Hyperthermie

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Abstract

Aim

Following mastectomy and adjuvant external beam radiation therapy in patients with breast cancer, the incidence of local or locoregional recurrence is approximately 9 % (2–20 %). Alongside the often limited possibilities of surgical treatment, radiation therapy combined with superficial hyperthermia is the most effective local therapy. In the present work, a retrospective analysis of salvage brachytherapy combined with superficial hyperthermia for chest wall recurrences is presented.

Patients and methods

Between 2004 and 2011, 18 patients with a total of 23 target volumes resulting from chest wall recurrences after previously mastectomy and external beam radiation therapy (median 56 Gy, range 50–68 Gy) were treated with superficial brachytherapy as salvage treatment: 8 patients (44 %) had macroscopic tumor, 3 (17 %) had microscopic tumor (R1), and 7 (39 %) had undergone R0 resection and were treated due to risk factors. A dose of 50 Gy was given (high-dose rate [HDR] and pulsed-dose rate [PDR] procedures). In all, 5 of 23 patients (22 %) received additional concurrent chemotherapy, and in 20 of 23 (87 %) target volumes additional superficial hyperthermia was carried out twice weekly.

Results

The 5‑year local recurrence-free survival was 56 %, the disease-free survival was 28 %, and a 5-year overall survival was 22 %. Late side effects Common Toxicity Criteria (CTC) grade 3 were reported in 17 % of the patients: 2 of 18 (11 %) had CTC grade 3 fibrosis, and 1 of 18 (6 %) had a chronic wound healing disorder.

Conclusion

Re-irradiation as salvage brachytherapy with superficial hyperthermia for chest wall recurrences is a feasible and safe treatment with good local control results and acceptable late side effects.

Zusammenfassung

Ziel

Nach einer Mastektomie und adjuvanter Strahlentherapie bei Patientinnen mit Mammakarzinom kommt es bei 9 % (2–20 %) zum lokalen bzw. lokoregionären Rezidiv. Neben den oft limitierten operativen Behandlungsmöglichkeiten ist die Strahlentherapie mit Oberflächenhyperthermie die effektivste Lokaltherapie. Im Folgenden wird eine retrospektive Analyse der Ergebnisse der Re-Bestrahlung als Salvage-Brachytherapie beim Brustwandrezidiv vorgestellt.

Patienten und Methode

In den Jahren 2004 bis 2011 wurden 18 Patientinnen mit insgesamt 23 Zielvolumina aufgrund eines Thoraxwandrezidivs nach bereits früher erfolgter Mastektomie und perkutaner Strahlentherapie. (Median 56 Gy, Spanne 50–68 Gy) mit einer Salvage-Oberflächen-Brachytherapie behandelt – 44 % Patientinnen mit makroskopischem Tumor, 17 % in einer R1-Situation und 39 % nach einer R0-Resektion aufgrund von Risikofaktoren. Die applizierte Dosis betrug 50 Gy („high-dose rate“ [HDR] und „pulsed-dose rate“ [PDR]). In 5/23 (22 %) Fällen wurde eine simultane Chemotherapie durchgeführt, bei 20/23 (87 %) Zielvolumina außerdem 2‑mal wöchentlich eine Oberflächenhyperthermie.

Ergebnisse

Das lokalrezidivfreie 5‑Jahres-Überleben betrug 56 %, das krankheitsfreie 5‑Jahres-Überleben 28 % und das 5‑Jahres-Gesamtüberleben 22 %. Bei 17 % der Patientinnen wurden chronische Nebenwirkungen nach den Common Toxicity Criteria (CTC) vom Grad 3 beobachtet, darunter 2/18 Patientinnen (11 %) mit einer Fibrose CTC Grad 3 und eine Patientin (1/18, 6 %) mit einer chronischen Wundheilungsstörung.

Schlussfolgerung

Die Salvage-Brachytherapie beim Thoraxwandrezidiv als Re-Bestrahlung in Verbindung mit Oberflächenhyperthermie stellt eine durchführbare und sichere Behandlung mit guter lokaler Kontrolle und akzeptablem Nebenwirkungsprofil dar.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital Erlangen, Universitätsstr. 27, 91054, Erlangen, Germany

    A. Auoragh,  V. Strnad MD, O. J. Ott & R. Fietkau

  2. Department of Radiation Oncology, Hospital Fuerth, Fuerth, Germany

    A. Auoragh

  3. Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany

    M. W. Beckmann

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  1. A. Auoragh
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  2. V. Strnad MD
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  3. O. J. Ott
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  5. R. Fietkau
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Correspondence to V. Strnad MD.

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A. Auoragh, V. Strnad, O.J. Ott, M.W. Beckmann, and R. Fietkau declare that they have no competing interests.

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Auoragh, A., Strnad, V., Ott, O.J. et al. Re-irradiation of the chest wall for local breast cancer recurrence. Strahlenther Onkol 192, 617–623 (2016). https://doi.org/10.1007/s00066-016-1010-z

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