Mature follow-up of Low-dose rate interstitial brachytherapy following ipsilateral breast tumor recurrence in patients initially treated with breast conservation therapy

Abstract

Objective: To evaluate our mature follow-up data in women who have developed IBTR following conservation surgery and post-operative external radiotherapy retreated by lumpectomy followed by interstitial brachytherapy in lieu of salvage mastectomy. Methods:Between 1/1998 and 10/2006, twenty-two patients with TIS or T1 IBTR were offered interstitial low-dose rate brachytherapy following tumor re-excision as an alternative to salvage mastectomy. All patients had failed lumpectomy followed by standard postoperative external beam radiotherapy (range 5000-6480cGy). The recurrent tumors were excised with final margins of resection free of residual disease. Tumor bed implantation was then carried out with an interstitial technique utilizing 192 Iridium with the target volume consisting of the tumor bed plus a minimum 1.0 centimeter margin (minimum standard dose 4500cGy). Results:With a mean follow up of 67.5 months (range 17-115 months) Twenty-one of 22 patients maintained local control at the time of last follow-up or at the time of their death. The single patient who developed a second local recurrence was treated successfully with mastectomy. Three patients succumbed to systemic disease. Two patients developed localized skin breakdown. One patient developed a contralateral breast cancer. Long-term cosmetic results as defined by the Harvard cosmesis scale and the Allegheny General modification were acceptable. Conclusions:These long-term data suggest that lumpectomy followed by brachytherapy is feasible and may be an acceptable alternative to salvage mastectomy in patients who locally fail conservation breast therapy. The upcoming RTOG retreatment trial (RTOG 1014) should help define the role of repeat conservation therapy in IBTR.

Second breast-conserving therapy with interstitial brachytherapy (APBI) as a salvage treatment in ipsilateral breast tumor recurrence: a retrospective study of 40 patients

“…While mastectomy is still widely used for salvage treatment, there is a growing trend towards breast-conserving approaches consisting of tumorectomy plus re-irradiation (particularly APBI). The available data suggest that this approach is a valid alternative to mastectomy [26,27,28]. Although no non-inferiority phase III studies are currently available, there is a growing body of evidence indicating that re-treatment with breast conserving procedures is both safe and effective, with excellent local control, survival, cosmesis, and patient’s satisfaction [26,27,28].…”

The critical nature of the multidisciplinary management of breast cancer: Not just an academic institutional exercise

“…For example, patients with ipsilateral pacemakers have recently been shown to safely undergo breast preservation [7] . Patients who develop ipsilateral breast cancer recurrences; once an absolute indication for mastectomy, have been safely and successfully retreated and their breasts preserved [8][9][10] . Patients with connective tissue disorders such as lupus erythematosis are many times considered to be poor radiation candidates due to excessive skin reactions, but reported safe treatment has been reported in selected women who have not had major exacerbations of skin reaction previously [11] .…”