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

Salvatore Cozzi; Dina Najjari Jamal; Andrea Slocker; Maria Laplana; Amparo Garcia Tejedor; Marco Krengli; Ferran Guedea; Cristina Gutierrez

doi:10.5114/jcb.2019.84689

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

J Contemp Brachytherapy. 2019 Apr;11(2):101-107. doi: 10.5114/jcb.2019.84689. Epub 2019 Apr 29.

Authors

Salvatore Cozzi¹, Dina Najjari Jamal², Andrea Slocker², Maria Laplana², Amparo Garcia Tejedor³, Marco Krengli⁴, Ferran Guedea², Cristina Gutierrez²

Affiliations

¹ Department of Radiation Oncology, Humanitas Cancer Center, Rozzano Milano, Italy.
² Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
³ Gynecology and Obstetrics Department, Hospital de Bellvitge, Barcelona, Spain.
⁴ Department of Radiation Oncology, "Ospedale Maggiore della Carità", Università degli studi del Pimonte Orientale, Novara, Italy.

Abstract

Purpose: Breast-conserving treatment (BCT) have emerged as an alternative to mastectomy in patients with ipsilateral breast tumor recurrence (IBTR). We evaluated survival outcomes and treatment-related toxicity in a series of 40 patients with IBTR, who underwent tumorectomy plus interstitial brachytherapy (APBI) as a salvage treatment.

Material and methods: Retrospective analysis included 40 patients diagnosed with IBTR and treated with intraoperative (26 patients) or post-operative (14 patients) multicatheter brachytherapy for APBI at our institution between June 2002 and October 2017. We assessed cosmesis, toxicity, overall survival (OS), and cancer-specific survival (CSS).

Results: Tumorectomy was performed in all cases, including intraoperative tumor margin assessment and sentinel node biopsy. Median age was 65 years (range, 41-92). The total prescribed dose was 32 Gy (8 fractions) in 19 patients and 34 Gy (10 fractions) in 20 patients. One elderly patient (age 92) received a single fraction of 16 Gy. Median follow-up was 61.5 months (range, 6-153). A median of 14 tubes were inserted. Mean treated V₁₀₀ was 115 cc. Two patients developed a second relapse at 3 and 5 years after salvage treatment: one patient underwent salvage mastectomy and remains alive 10 years after brachytherapy, and the second one developed both local relapse and bone metastasis. The disease is stable at present. Five-year OS and CSS rates were 85.3% and 97.5%, respectively. Two patients died from cancer-related causes. Acute and late toxicity rates were low; seven patients developed acute infectious mastitis. Late fibrosis > grade 3 and late mastitis were observed in 14 and 6 cases, respectively.

Conclusions: Second BCT with APBI as a salvage treatment in ipsilateral breast recurrence achieves good local disease control, with a satisfactory toxicity profile compared to mastectomy. This approach seems to be safe and effective, although more data from randomized trials are needed.

Keywords: APBI; brachytherapy; breast cancer; local relapse; salvage brachytherapy.