To evaluate lumpectomy and partial breast external beam irradiation for treatment of an in-breast tumor recurrence after previous lumpectomy and whole breast irradiation for stage 0, I and II cancer of the breast.
Fifty-one women were treated with lumpectomy and partial breast irradiation for an in-breast tumor recurrence after previous lumpectomy and whole breast irradiation including one patient who had bilateral repeat partial breast irradiation. Six breast cancers were initially treated with lumpectomy alone whereas the remainder had an axillary node dissection. The interval from the end of the first course of breast irradiation to the diagnosis of an in-breast tumor recurrence ranged from 16-291 months (median 68.5). The initial breast cancer was invasive in 42 breasts and ductal carcinoma in situ (DCIS) in 10. The IBTR in 36 breasts was invasive and in 16, DCIS. All patients had a repeat course of radiotherapy using electrons to treat the new operative area with 5000 cGy in 25 fractions except for one who received only 3200 cGy in 16 fractions, having discontinued treatment for non-medical reasons.
The repeat course of partial breast irradiation was well tolerated in all patients. There have been no late serious sequellae such as skin, bone, or soft tissue necrosis. In followup of one to 225 months (median 79 months for living patients), there have been five subsequent solitary in-breast tumor recurrences and all are alive without evidence of disease following mastectomy. An additional six patients had a subsequent IBTR with concomitant distant metastases. Five have subsequently died. Four additional patients died with distant metastases but no evidence of IBTR. One patient developed recurrence in the axilla subsequently treated by surgery and she died free of disease. Two patients are alive with metastatic non-breast cancer. Five of seven patients whose initial cancers involved axillary nodes died of distant metastases after developing their first IBTR.
A repeat course of partial breast irradiation to a dose of 5000 cGy in 25 fractions may be appropriate management for an IBTR in a patient who wishes to avoid mastectomy.
Deutsch, M,
Lumpectomy and Partial Breast External Beam Irradiation for Treatment of in-Breast Tumor Recurrence after Previous Lumpectomy and Whole Breast Irradiation. Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL.
http://archive.rsna.org/2005/4408487.html
