Second breast conserving therapy after ipsilateral breast tumor recurrence - a 10-year experience of re-irradiation

Tobias Forster; Sati Akbaba; Daniela Schmitt; David Krug; Rami El Shafie; Jan Oelmann-Avendano; Katja Lindel; Laila König; Nathalie Arians; Denise Bernhardt; Frederik Marmé; Andreas Schneeweiss; Jörg Heil; Christof Sohn; Jürgen Debus; Juliane Hörner-Rieber

doi:10.5114/jcb.2019.87001

Second breast conserving therapy after ipsilateral breast tumor recurrence - a 10-year experience of re-irradiation

J Contemp Brachytherapy. 2019 Aug;11(4):312-319. doi: 10.5114/jcb.2019.87001. Epub 2019 Aug 29.

Authors

Tobias Forster^{1

2

3}, Sati Akbaba^{1

2

3}, Daniela Schmitt^{1

2

3}, David Krug^{1

4}, Rami El Shafie^{1

2

3}, Jan Oelmann-Avendano^{1

2

3}, Katja Lindel⁵, Laila König^{1

2

3}, Nathalie Arians^{1

2

3}, Denise Bernhardt^{1

2

3}, Frederik Marmé^{6

7}, Andreas Schneeweiss^{3

7}, Jörg Heil^{6

7}, Christof Sohn⁶, Jürgen Debus^{1

2

3

8

9

10}, Juliane Hörner-Rieber^{1

2

3

8}

Affiliations

¹ Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
² Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.
³ National Center for Tumor Diseases (NCT), Heidelberg, Germany.
⁴ Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany.
⁵ Department of Radiation Oncology, Municipal Hospital, Karlsruhe, Germany.
⁶ Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany.
⁷ German Cancer Research Center (DKFZ), Heidelberg, Germany.
⁸ Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
⁹ Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
¹⁰ German Cancer Consortium (DKTK), partner site Heidelberg, Germany.

Abstract

Purpose: The aim of this study is to evaluate the efficacy and toxicity of post-operative partial breast re-irradiation with multi-catheter brachytherapy after second breast conserving therapy (BCT) in patients with small, low-risk ipsilateral breast tumor recurrence (IBTR).

Material and methods: Between 2008 and 2018, 19 consecutive patients with low-risk IBTR (max. rpT1 cN0 cM0, Her2 negative, preferably positive hormone receptor status) who refused mastectomy were treated with salvage lumpectomy, followed by post-operative partial breast re-irradiation with multi-catheter brachytherapy. Eight patients were irradiated using PDR brachytherapy (49.8-50.4 Gy in pulses of 0.5-0.7 Gy) and 11 patients using HDR brachytherapy (34.2 Gy in fractions of 3.8 Gy or 32 Gy in fractions of 4 Gy). All patients had undergone prior BCT for their primary tumor, followed by adjuvant whole breast radiotherapy. Local control (LC), locoregional control (LRC), overall survival (OS), disease-free survival (DFS) as well as toxicity were evaluated in the present study.

Results: After a median follow-up of 65 months following IBTR (18-120 months), only one second IBTR in 19 patients was diagnosed 77 months after re-irradiation, resulting in a LC rate of 100% at 5 years. DFS and OS rates were both 100% at 5 years following re-irradiation. Except for the above mentioned second IBTR, no regional or distant relapse was recorded. Regarding toxicity, 63% of patients developed adverse events (CTCAE grade ≤ 2), with fibrosis detected in 37% (7/19) of patients, necrosis in 11% (2/19), hyperpigmentation in 47% (9/19), and telangiectasia in 11% (2/19), respectively. No patient showed a high-grade (CTCAE grade ≥ 3) adverse event.

Conclusions: In case of small, low-risk IBTR, adjuvant re-irradiation using multi-catheter brachytherapy is a feasible, safe, and effective treatment method after repeated lumpectomy, and an alternative to mastectomy.

Keywords: brachytherapy; breast cancer; ipsilateral breast tumor recurrence; re-irradiation; second breast conserving therapy.