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Radiother Oncol. 2015 Nov;117(2):223-8. doi: 10.1016/j.radonc.2015.10.017. Epub 2015 Nov 2.

Reirradiation and hyperthermia for irresectable locoregional recurrent breast cancer in previously irradiated area: Size matters.

Author information

1
Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands. Electronic address: s.oldenborg@amc.uva.nl.
2
Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands.
3
Department of Radiation Oncology, Institute Verbeeten (BVI), Tilburg, The Netherlands.
4
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.

Abstract

BACKGROUND/PURPOSE:

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.

PATIENTS/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.

CONCLUSION:

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.

KEYWORDS:

Hyperthermia; Recurrent breast cancer; Reirradiation

PMID:
26542015
DOI:
10.1016/j.radonc.2015.10.017
[Indexed for MEDLINE]

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