Locally Recurrent Breast Cancer: Pulse Dose Rate Brachytherapy for Repeat Irradiation Following Lumpectomy—A Second Chance to Preserve the Breast

Resch, Alexandra; Fellner, Claudia; Mock, Ulrike; Handl-Zeller, L; Biber, Eva; Seitz, W.; Pötter, Richard

doi:10.1148/radiol.2253011913

Cited by 102 publications

(56 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…34 In this study from Vienna University, 9 patients were treated with partial breast irradiation with interstitial pulse dose rate brachytherapy with 40.2-50 Gy, and 8 patients were treated with repeat whole breast irradiation with 30 Gy combined with an additional pulse dose rate interstitial brachytherapy boost dose of 12.5 Gy to the surgical bed. Recurrences were diagnosed at a median follow-up of 50 months (range, 11-208 months) after the completion of treatment for the initial breast tumor.…”

Section: Reported Experiences With Reirradiation Of the Surgical Bed mentioning

confidence: 99%

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Kuerer

Arthur

Haffty

2004

Cancer

View full text Add to dashboard Cite

Mastectomy is the current standard of care for in-breast local recurrence of breast carcinoma. The objective of the current study was to critically review the rationale for and the theoretic and actual risks and benefits of repeat breast-conserving surgery followed by partial breast irradiation (PBI) for in-breast local recurrence of breast carcinoma. The main outcomes of interest were local control and survival after in-breast local recurrence and side effects, complications, and cosmesis after reirradiation of the breast. The risk of local recurrence was not found to be eliminated with mastectomy; approximately 2-32% of patients treated with mastectomy develop a chest wall recurrence. The interpretation of local control rates in evaluating repeat breast-conserving surgery studies is difficult because of the lack of information regarding preoperative diagnostic mammography to rule out concurrent multicentric disease and microscopic margin status after surgery. Rates of subsequent local recurrence in these studies appeared to be between 19 -50%, similar to reported rates of in-breast local recurrence in patients with a first diagnosis of breast carcinoma who were treated with conservative surgery without irradiation. Early follow-up studies of breast reirradiation suggest that catheterbased interstitial brachytherapy and standard external beam radiation therapy can be delivered to the breast more than once without significant side effects in most patients and with acceptable cosmesis in some patients. Mastectomy may not be necessary in all patients with an in-breast local recurrence of breast carcinoma. KEYWORDS: recurrent breast carcinoma, breast surgery, radiation therapy, accelerated partial breast irradiation, three-dimensional conformal radiation therapy, brachytherapy.A t present, the standard surgical approach for the treatment of in-breast local recurrence of breast carcinoma is mastectomy. The rationale for the general consensus for this recommendation is threefold. First, a third local recurrence after repeat conservative surgery is reported in approximately 35% of patients. Second, a second lumpectomy would yield a cosmetically unacceptable outcome. Third, reirradiation of the whole breast after breast-conserving surgery is considered inappropriate because of the likelihood of serious tissue damage. Recently, novel brachytherapy devices and three-dimensional conformal radiation therapy techniques have brought accelerated partial breast irradiation (APBI) to the forefront as a potential treatment approach in women with in-breast local recurrence of 2269

show abstract

Section: Reported Experiences With Reirradiation Of the Surgical Bed mentioning

confidence: 99%

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Kuerer

Arthur

Haffty

2004

Cancer

View full text Add to dashboard Cite

show abstract

“…In comparison with salvage mastectomy series, the results were reported to be at least equivalent, with 5- and 10-year actuarial rates for metastatic recurrence of 9.6% and 19.1%, DFS rates of 84.6% and 77.2%, and OS rates of 88.7% and 76.4%, respectively. Further single-institution studies with small patient numbers support these data [35,36,37,38]. …”

Section: Therapy Of Ipsilateral Breast Tumor Recurrencementioning

confidence: 80%

Current Treatment of Isolated Locoregional Breast Cancer Recurrences

et al. 2015

View full text Add to dashboard Cite

Patients with isolated locoregional breast cancer recurrences should be treated with curative intent. Mastectomy is regarded as the standard of care for patients with ipsilateral breast tumor recurrence. In a selected group of patients, partial breast irradiation after second breast-conserving surgery is a viable alternative to mastectomy. If a second breast conservation is performed, additional irradiation should be mandatory, especially in patients who had not been irradiated previously. In case of re-irradiation, the largest experience exists for multi-catheter brachytherapy. Prospective clinical trials are needed to clearly define selection criteria, long-term local control, and toxicity. In patients with resectable locoregional breast cancer recurrences after mastectomy, multi-modal therapy comprising complete resection, radiation therapy in previously unirradiated patients, and systemic therapy results in 5-year disease-free and overall survival rates of 69% and 88%, respectively. In radiation-naive patients with unresectable, isolated locoregional recurrences, radiation therapy is mandatory. In selected patients with previous irradiations and unresectable locoregional recurrences, a second irradiation as part of an individual treatment concept can be applied. The increased risk of severe toxicity should always be weighed up against the potential clinical benefit. A combination therapy with hyperthermia can further improve the treatment results.

show abstract

“…[20][21][22][23][24][25][26][27][28][29][30][31][32] Three articles were results of the German-Austrian accelerated partial breast irradiation (APBI) Phase II study. 22,25,26 Because the most recent data published by Ott et al did not include data on toxicity, we included the other two articles in our analysis.…”

Section: 12mentioning

confidence: 99%

“…25,26 In recurrent breast cancer, most studies 20,21,24,29,30,32 treated only locally with interstitial tubes or a chest wall mould. Resch et al 32 and four patients in the study of Niehoff et al 24 combined brachytherapy with EBRT. Treatment planning was performed on X-ray or CT scan, and some studies performed a geometrical optimization.…”

Section: 12mentioning

confidence: 99%

A review of the clinical experience in pulsed dose rate brachytherapy

Balgobind

Koedooder

Zúñiga

et al. 2015

BJR

View full text Add to dashboard Cite

Pulsed dose rate (PDR) brachytherapy is a treatment modality that combines physical advantages of high dose rate (HDR) brachytherapy with the radiobiological advantages of low dose rate brachytherapy. The aim of this review was to describe the effective clinical use of PDR brachytherapy worldwide in different tumour locations. We found 66 articles reporting on clinical PDR brachytherapy including the treatment procedure and outcome. Moreover, PDR brachytherapy has been applied in almost all tumour sites for which brachytherapy is indicated and with good local control and low toxicity. The main advantage of PDR is, because of the small pulse sizes used, the ability to spare normal tissue. In certain cases, HDR resembles PDR brachytherapy by the use of multifractionated low-fraction dose.

show abstract

Locally Recurrent Breast Cancer: Pulse Dose Rate Brachytherapy for Repeat Irradiation Following Lumpectomy—A Second Chance to Preserve the Breast

Abstract: Local tumor excision combined with PDR brachytherapy for small local-regional tumor recurrences after primary BCT is feasible and well tolerated and might obviate mastectomy. Preliminary experiences are encouraging. Further studies are required for appropriate patient selection.

Cited by 102 publications

References 31 publications

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Current Treatment of Isolated Locoregional Breast Cancer Recurrences

A review of the clinical experience in pulsed dose rate brachytherapy

Contact Info

Product

Resources

About