NRG Oncology/RTOG 1014: 3 Year Efficacy Report From a Phase II Study of Repeat Breast Preserving Surgery and 3D Conformal Partial Breast Re-Irradiation (PBrI) for In-Breast Recurrence

Arthur, Douglas W.; Moughan, Jennifer; Kuerer, HM; Haffty, Bruce G.; Cuttino, L.W.; Todor, Dorin; Simone, Nicole L.; Hayes, S.B.; Woodward, Wendy A.; McCormick, Beryl; Cohen, R.J.; Sahijdak, Walter M.; Canaday, Daniel J.; Brown, Doris R.; Currey, Adam; Fisher, Christine M.; Jagsi, Reshma; White, Julia

doi:10.1016/j.ijrobp.2016.09.054

Cited by 15 publications

(7 citation statements)

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“…With 55 reported patients on study, most patients experienced only grade 1 toxicity (64%, dermatitis, fibrosis and/or breast pain) and 7% grade 2 with only 1 (less than 2%) with grade 3 fibrosis of deep connective tissue. With 3.6 years median follow‐up, second local recurrence rate was 3.7%, and the authors concluded that partial breast re‐irradiation with 3‐dimensional conformal radiation therapy after salvage lumpectomy due to IBTR is safe and feasible …”

Section: Discussionmentioning

confidence: 99%

Local recurrence of breast cancer: Salvage lumpectomy as an option for local treatment

et al. 2019

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Introduction The best local management for breast cancer recurrence following conservative treatment for breast cancer (BC) continues to be an open question. In this study, we compared patients' outcome after salvage lumpectomy (SL) vs mastectomy for ipsilateral breast tumor recurrence (IBTR). Materials and methods Between 1987 and 2014 we identified 121 patients with pT0‐2, N0‐3, M0 BC who had BCT as their primary treatment, and subsequently had IBTR (unifocal). 47 patients underwent SL and 74 salvage mastectomy (SM) as the local treatment for their 1st recurrence. Results Median follow‐up was 14 years (1‐30) from first BC diagnosis. For the SL and SM cohorts, 8 and 10 patients (17%, 13.5%, P = 0.22), respectively, developed subsequent local recurrence as a 3rd event. Although in MVA, woman who underwent SL had higher chances of having a 2nd recurrence (3rd event), P = 0.020, at a median follow‐up of 14 years, 95.8% of SL patients are alive, NED, 85% are mastectomy free. 87% of patients who opted for SM are alive, NED. Having re‐irradiation following SL did not protect against 2nd breast cancer recurrence (3rd event, P = 0.42). Conclusion Salvage lumpectomy following IBTR, while associated with higher second LR rate than SM is not associated with inferior outcome. With survival >95% at 14 years in the SL cohort, salvage lumpectomy with or without re‐radiation, in a selected population (unifocal T), represents an acceptable treatment option for patients in order to delay time to mastectomy without reducing BC survival. Both options should be discussed prior to any surgical decision.

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Section: Discussionmentioning

confidence: 99%

Local recurrence of breast cancer: Salvage lumpectomy as an option for local treatment

et al. 2019

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“…Whereas after primary BCS radiologically occult lesions could theoretically be eradicated by whole-breast radiotherapy, repeat whole-breast external beam radiotherapy is generally considered a contraindication in the previously irradiated breast due to the risk of skin toxicity. The feasibility of partial breast re-irradiation after a repeat BCS is currently under investigation and preliminary results are promising [38][39][40][41]. However, this technique does not allow the elimination of any occult lesions in other quadrants of the breast.…”

Section: Discussionmentioning

confidence: 99%

Local staging of ipsilateral breast tumor recurrence: mammography, ultrasound, or MRI?

Walstra

Schipper

Winter-Warnars

et al. 2020

Breast Cancer Res Treat

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Background Despite increasingly effective curative breast-conserving treatment (BCT) regimens for primary breast cancer, patients remain at risk for an ipsilateral breast tumor recurrence (IBTR). With increasing interest for repeat BCT in selected patients with IBTR, a reliable assessment of the size of IBTR is important for surgical planning. Aim The primary aim of this study is to establish the performance in size estimation of XMG, US, and breast MRI in patients with IBTR. The secondary aim is to compare the detection of multifocality and contralateral lesions between XMG and MRI. Patients and methods The sizes of IBTR on mammography (XMG), ultrasound (US), and magnetic resonance imaging (MRI) in 159 patients were compared to the sizes at final histopathology. The accuracy of the size estimates was addressed using Pearson’s coefficient and Bland–Altman plots. Secondary outcomes were the detection of multifocality and contralateral lesions between XMG and MRI. Results Both XMG and US significantly underestimated the tumor size by 3.5 and 4.8 mm, respectively, while MRI provided accurate tumor size estimation with a mean underestimation of 1.1 mm. The sensitivity for the detection of multifocality was significantly higher for MRI compared to XMG (25.5% vs. 5.5%). A contralateral malignancy was found in 4.4% of patients, and in 1.9%, it was detected by MRI only. Conclusion The addition of breast MRI to XMG and US in the preoperative workup of IBTR allows for more accurate size estimation. MRI provides a higher sensitivity for the detection of multifocality compared to XMG.

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“…Their preliminary outcomes were reported at the recent American Society for Radiation Oncology conference, describing a 3-year subsequent IBTR of 3.7%, DMFS and OS of 94.8% in a cohort of 58 patients. Four patients underwent subsequent mastectomy, two for a subsequent IBTR, one for a non-healing wound and another patient who underwent bilateral mastectomy after discovery of contralateral disease ( 30 ). They describe grade 1 late toxicity (greater than 1 year from treatment) in 24.1% of patients mainly consisting of breast pain and fibrosis, grade 2 late toxicity in 22.4%, and grade 3 toxicity in 6.9% with one instance of grade 3 infection.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Partial Breast Reirradiation with Intraoperative Radiotherapy after Prior Thoracic Radiation: A Single-Institution Report of Outcomes and Toxicity

et al. 2017

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IntroductionMastectomy is the current standard of care for ipsilateral breast tumor recurrences after prior whole breast irradiation (WBI). We report our single-institution experience with breast-conserving surgery (BCS) followed by intraoperative radiotherapy (IORT) as an alternative to salvage mastectomy for new or recurrent breast cancers that develop in the setting of prior thoracic radiation.MethodsWe performed an IRB-approved retrospective review of patients treated with breast IORT between September 2013 and November 2016. We identified 12 patients who declined salvage mastectomy for their breast cancer after prior thoracic radiation. IORT was delivered using the Intrabeam™ device (Carl Zeiss, Germany). A dose of 20 Gy was prescribed to the lumpectomy cavity surface using 50 kV X-rays. We graded both acute and late treatment-related breast toxicities using the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Local control, mastectomy-free survival, distant metastasis, and overall survival were determined.ResultsOur study included nine patients who developed a new or recurrent ipsilateral breast cancer after prior WBI for early-stage breast cancer, two patients with primary breast cancer after mantle-field radiation for Hodgkin’s lymphoma, and one patient with a synchronous stage III non-small cell lung cancer treated with definitive radiation to the ipsilateral lung and mediastinum. The median time from prior radiation to presentation was 18 years (range: 2 months to 46 years). All patients successfully underwent partial breast reirradiation with IORT and were able to preserve their breast. At a median follow-up of 14 months (4–25 months), there were no local or distant recurrences. There was a single non-cancer-related death. In the acute setting, we observed grade 1 toxicity in 58% (n = 7), grade 2 toxicity in 17% (n = 2), and no grade 3 or higher toxicity. In the late setting, at least 3 months after IORT, we observed grade 1 hyperpigmentation and/or fibrosis in 50% (n = 6), symptomatic seroma requiring drainage in 33% (n = 4). A single patient developed an abscess requiring hospitalization and intravenous antibiotic therapy.ConclusionBCS with IORT is a feasible salvage option for patients who present with localized breast cancer after prior thoracic radiation treatment. Continued follow-up of these patients is warranted given the incidence of delayed toxicity.

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NRG Oncology/RTOG 1014: 3 Year Efficacy Report From a Phase II Study of Repeat Breast Preserving Surgery and 3D Conformal Partial Breast Re-Irradiation (PBrI) for In-Breast Recurrence

Cited by 15 publications

References 0 publications

Local recurrence of breast cancer: Salvage lumpectomy as an option for local treatment

Local recurrence of breast cancer: Salvage lumpectomy as an option for local treatment

Local staging of ipsilateral breast tumor recurrence: mammography, ultrasound, or MRI?

Evaluation of Partial Breast Reirradiation with Intraoperative Radiotherapy after Prior Thoracic Radiation: A Single-Institution Report of Outcomes and Toxicity

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