Reirradiation with concurrent hyperthermia for recurrent breast cancer is safe and effective.

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International Journal of Radiation Oncology, Biology, Physics


Purpose/Objective(s): Hyperthermia is a radiation sensitizer employed in conjunction with radiotherapy (RT) in the setting of reirradiation or inoperable breast masses involving the skin. We present our experience treating locally recurrent breast cancer with radiotherapy and concurrent hyperthermia. Materials/Methods: An institutional hyperthermia database was queried for all patients who underwent concurrent hyperthermia with breast RT. Hyperthermia was delivered twice-weekly per institutional protocol with active thermal electrode monitoring. The area of interest was heated to a target of 43 C for one hour approximately 20 minutes prior to radiation treatments. Demographic information, initial and subsequent RT course information, clinical outcomes, and toxicity data were collected. Freedom from local progression was analyzed with cumulative incidence competing risk method with death as a competing risk and overall survival was calculated with the Kaplan-Meier technique. Toxicity was graded per CTCAE version 3.0. Results: Forty-one patients were identified and analyzed. The median doses for the first and second courses of RT were 6040 cGy and 5000 cGy, respectively. The median total dose was 11000 cGy (range, 7500-12840). The median interval between radiation courses was 115 months (range, 4- 443). Sites of recurrence at the time of repeat RT included 75% chest wall, 5% chest wall and regional lymphatics, 13% breast only, and 8% breast and regional lymphatics. The median age at the time of reirradiation was 60 (range, 41-87). The median follow-up from the second course of RT was 8 months (range, 1-141). During the re-irradiation course, 5% received proton therapy and 10% received concurrent chemotherapy. Sixty-four percent received irradiation to the whole chest wall, 28% to the whole chest wall and regional lymphatics, 5% to the partial chest wall, and 1% to the whole breast. Of 18 patients with gross disease prior to reirradiation, 67% had resolution of their original gross disease after repeat RT and then went on to receive further systemic therapy. The 1-year freedom from local progression estimate for all patients was 96% and the 1-year overall survival estimate was 83%. There were no noted associations between reirradiation variables and superior freedom from local progression. Eight patients required treatment breaks of a median 2.5 days (range, 1-3). Two patients developed acute grade 3 toxicity, including radiation dermatitis/ ulceration (nZ2), chest wall pain (nZ1), and hypopigmentation (nZ1). Five patients developed chronic grade 3 toxicity, including hyperpigmentation (nZ3), radiation dermatitis/ulceration (nZ2), induration/ fibrosis (nZ2), and telangiectasias (nZ1). Conclusion: Re-irradiation with concurrent hyperthermia yields excellent local response rates with acceptable toxicity in patients with recurrent breast cancer. Clinicians should consider aggressive local therapy with radiotherapy and thermal sensitization in this clinical context.





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