• Users Online: 368
  • Print this page
  • Email this page


 
 
Table of Contents
REVIEW ARTICLE
Year : 2018  |  Volume : 1  |  Issue : 2  |  Page : 84-88

Reirradiation in breast malignancies


1 Department of Radiation Oncology, Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam, Andhra Pradesh, India
2 Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication31-Dec-2018

Correspondence Address:
Dr. Venkata Krishna Reddy Pilaka
Mahatma Gandhi Cancer Hospital & Research Institute, 1/7, MVP Colony, Visakhapatnam, Andhra Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCO.JCO_17_18

Get Permissions

  Abstract 

Ipsilateral breast or chest wall recurrence remains one the most common site of disease recurrence and significantly increases the morbidity and mortality. The current standard of care for ipsilateral breast tumour recurrence has been mastectomy. However, various recent studies showed that there is feasibility of repeat breast conservation surgery with reirradiation. Reirradiation in breast cancer is complicated approach. Many physicians are reluctant to reirradiate breast with restricted data available. This paper will review the current literature on reirradiation for locally recurrent breast cancer

Keywords: Reirradiation, breast cancer, local recurrence, whole breast radiation, post mastectomy radiation


How to cite this article:
Pilaka VK, Patro KC, Bhattacharyya PS, Kundu CR, Palla M, Balakrishnan R. Reirradiation in breast malignancies. J Curr Oncol 2018;1:84-8

How to cite this URL:
Pilaka VK, Patro KC, Bhattacharyya PS, Kundu CR, Palla M, Balakrishnan R. Reirradiation in breast malignancies. J Curr Oncol [serial online] 2018 [cited 2019 May 25];1:84-8. Available from: http://www.journalofcurrentoncology.org/text.asp?2018/1/2/84/249056


  Introduction Top


Data from several randomized trials have shown that locoregional recurrences occur in approximately 5%–15% of patients despite adjuvant radiotherapy after primary mastectomy or breast conservation surgery (BCS). Ipsilateral breast or chest wall remains the most common site of recurrence, comprising 60%–95% of all locoregional events.[1],[2],[3],[4],[5] Early breast cancer trialists’ collaborative group meta-analysis reported that approximately one breast cancer death was avoided by year 15 for every four recurrences avoided by year 10. The mortality reduction did not differ significantly between node positive and negative disease.[6] Multiple retrospective studies have shown that local recurrence after curative treatment would lead to increased risk of distant metastases and breast cancer mortality.[7],[8],[9] It is therefore essential to know the importance of treating the local recurrence in breast cancer so as to prevent distant metastases and breast cancer mortality. This article discusses various treatment options and techniques for local recurrences in breast cancer both after BCS and mastectomy.

The current standard of care for ipsilateral breast tumor recurrence (IBTR) is mastectomy. However, there is a large body of evidence, which describes repeat BCS in setting of locally recurrent disease. The local recurrence rates (LRRs) in repeat BCS alone are approximately 20%–40% at 5 years.[10],[11],[12],[13],[14] In view of this, various trials have tested the feasibility of reirradiation to IBTR after BCS to minimize LRRs. Various methods of treatments such as external beam radiation therapy (EBRT), intraoperative radiation therapy (IORT), and brachytherapy have been described for reirradiation in breast cancer.

There are no definite guidelines for choosing second course of BCS for either new ipsilateral neoplasm or recurrent lesions. Local recurrences usually occur in the same quadrant, with similar histology and usually within 5 years of completion of treatment. Identifying second primary from recurrence is important as recurrence is independent predictor for breast cancer mortality, whereas prognosis of primary lesions depends on stage.[15] Criteria for BCS have proposed for those with disease-free interval greater than 3 years, absence of late radiation changes in skin or breast tissue, early T stage (<3cm primary), and absence of involved nodes in new lesion.[16] DEGRO of the German society of radiation oncology practical guidelines for radiotherapy in breast cancer, published in April 2016, defined selection criteria for second BCS after IBTR as: (a) isolated IBTR, (b) size <2–3cm, (c) unifocal disease on imaging, (d) age >50 years, (e) long interval between primary treatment and recurrence (>48 months), (f) patient’s preference, and also (g) technical feasibility of second BCS.[17]


  Imaging Modalities to Detect Local Recurrence Top


Various guidelines including the American Society of Clinical Oncology, European Society of Medical Oncology, and National Cancer Care Network guidelines recommend only history and physical examination every three monthly for 2 years and every six monthly thereafter and annual mammography.[18],[19],[20],[21] Digital breast tomosynthesis delivers multiple thin images through the breast by acquiring mammographic projections at different angles. Even though it has been shown that there is increased detection rates and lesser false positive in screening programs, its role in detecting recurrences needs further research.[22] Whole breast ultrasound has been used for evaluation of palpable breast abnormalities as well as evaluation of masses seen on mammography. No studies have been available for surveillance after BCS. Breast cancer subtype is also associated with development of local recurrences and distant metastases. Luminal B breast cancer has a higher hazard of breast cancer recurrence and shorter overall survival compared with Luminal A breast cancer. This differential pattern of recurrence might vary the schedule and intensity of surveillance accordingly in future.[23]


  Second Breast-Conserving Surgery with Reirradiation Top


With external beam radiation therapy

EBRT was used to reirradiate with IBTR as early as mid-1980s. Deutsch[24] reported 40 women with IBTR following BCS and radiation therapy (RT). They received initial RT dose of 50 Gy to the whole breast in 2 Gy per fraction, with or without boost. Median time of recurrence was 63 months from initial treatment. Partial breast reirradiation (PBrI) to dose of 50 Gy in 2 Gy per fraction was delivered to entire operative quadrant using electrons of appropriate energy. Treatment was well tolerated but alternated in skin pigmentation. It was reported that 25% of evaluated patients were having fair to poor cosmesis.[24] Würschmidt[25] reported four patients receiving reirradiation with good cosmetic results and no grade 3 or higher toxicity.

RTOG 1014 results published 1-year toxicity report from a phase II study of repeat BCS and PBrI for IBTR in August 2017. Eligibility criteria included IBTR occurring more than 1 year after previous radiation, <3cm, unifocal, and resected with negative margins. PBrI was targeted to surgical cavity plus 1.5cm, prescription dose of 45 Gy in 1.5 Gy twice daily for 30 treatments. Sixty-five patients were accrued and treated. Treatment-related skin fibrosis and breast pain were recorded as grade 1 in 64% and grade 2 in 7% with only one patient with grade more than 3 and identified as grade 3 fibrosis of deep connective tissue. It was concluded that PBrI after second BCS is safe and feasible with acceptable treatment toxicity.[26]

With intraoperative radiation therapy

In a single institution study, a total of 15 patients from Germany were treated by IORT with 50kV X-rays, applicator size of 4cm, which delivered single dose of 14.7–20 Gy to the applicator surface. No local recurrences were noted at median follow-up of 26 months (1–60 months). IORT was well tolerated with no grade 3 or higher toxicity with excellent cosmetic outcomes.[27]

Brachytherapy after BCS for IBTR

The most solid evidence for reirradiation of IBTR exists for brachytherapy. The Groupe Européen de Curiethérapie and the European Society for Radiotherapy and Oncology (GEC-ESTRO) working group reported on a retrospective collaborative analysis of 217 patients with IBTR treated between 2000 and 2009 with multicatheter brachytherapy in eight European institutions.[28] The median total doses delivered through low-dose rate (LDR) and pulsed-dose rate brachytherapy were 46 Gy (range, 30–55 Gy) and 50.4 Gy (range, 49–50 Gy), respectively. With high-dose rate (HDR) brachytherapy, the median dose delivered was 32 Gy (range, 22–36 Gy; equivalent dose in 2-Gy fractions: 43 Gy4) in 5–10 fractions (median, 8 fractions) (twice daily). With a median follow-up of 3.9 years (1.1–10.3 years) after IBTR retreatment, the 5- and 10-year actuarial second LRRs were 5.6% (1.5%–9.5%) and 7.2% (2.1%–12.1%), respectively. The grade 3 and 4 complication rates were 10% and 1% (ulceration), respectively. Excellent or good cosmetic results were achieved in 85%. In comparison to salvage mastectomy series, results were reported to be at least equivalent with 5- and 10-year actuarial rates for metastatic recurrence of 9.6% and 19.1%, disease-free survival of 84.6% and 77.2%, and overall survival of 88.7% and 76.4%, respectively. Further single-institution studies with few patients support these data.[29],[30],[31],[32]

A French retrospective study of almost 70 patients who underwent repeat lumpectomy followed by interstitial brachytherapy revealed promising 5-year Overall survival (OS) and freedom from second local recurrence (FFLR2). A 77% rate of FFLR2 was noted in 70 patients. Interestingly, in this group of patients treated with interstitial brachytherapy, multivariate analysis revealed the subset of patients treated with five or more wires had a markedly improved FFLR2 of nearly 95% at 5 years. This treatment was well tolerated with minimal acute toxicity, and only 10% rate of late grade 3 toxicity was noted, most commonly fibrosis.[28]

A much larger retrospective series of 217 patients receiving second conservative treatment with lumpectomy and interstitial brachytherapy was reported on at the World Congress of Brachytherapy in 2012. The 5-year LRR was a promising 5.6% with actuarial OS at 5 years reported as 88.7%. Furthermore, cosmesis was good to excellent in 85% of patients with an 11% rate of grade 3 and 4 toxicity noted.[33]

A smaller phase I/II study used LDR brachytherapy, initially to a total dose of 30 Gy in six patients. The dose was escalated to 45 Gy for the subsequent nine patients as toxicity was minimal. Consistent with the majority of data, an admixture of systemic therapy was reported with a portion of patients receiving chemotherapy or hormonal therapy.[34]

In this phase I/II trial, Chadha et al.[31] reported an 89% local control rate, but the number of patients was low and median follow-up was only 36 months. However, similar 5-year actuarial local control of 93% was seen in the larger Austrian study with a median follow-up of 57 months. In this study, 5-year OS and disease free survival (DFS) were 87% and 77%, respectively. Ten-year actuarial data were reported in the Spanish study, showing an OS of 96.7%, DFS of 64.4%, and local control of 89.4%.[31]

Guix et al.[34] analyzed long-term results of pilot study conducted on 36 patients with breast-only recurrences less than 3cm in diameter, who underwent HDR brachytherapy (30 Gy in 12 fractions over 5 days) and reported low treatment-related toxicity, with no grade 3 or 4 events reported. Cosmetic results were satisfactory in 90.4%. Kauer-Dorner et al.[30] noted grade 3 breast tissue fibrosis in one woman and three women had grade 3 pain. Poor or unacceptable cosmesis was documented in six patients by independent observers; however, only two patients self-reported this level of cosmetic outcome. Thus, equivalent local tumor control to mastectomy was obtained by second breast conservation therapy with good cosmesis and moderate morbidity. Overall, the addition of PBrI to repeat breast-conserving surgery appears to be both efficacious and well tolerated. However, when considering the use of a second breast-conserving therapy, it is important to remember that the study populations were highly selected patients with small local recurrences occurring more than 1 year from initial treatment.[34]


  Repeat Chest Wall Irradiation for Local Recurrence after Mastectomy Top


Repeat chest wall radiotherapy is controversial because of high cumulative doses that would cause potential toxicity. Local control with repeat surgery alone remains unacceptable with 5-year local control rates of only 33%. Therefore, the use of repeat chest wall RT has been explored for a second curative intent treatment despite the concerns over possible toxicity.[35]

In a multi-institutional study conducted by Wahl et al.,[36] 81 patients underwent reirradiation of the breast or chest all for local recurrence. The median dose of the first course of radiation was 60 Gy and was 48 Gy for second course. Median dose for the second treatment course was 48 Gy. Two-thirds of patients were free of local disease at 12 months, with the local DFS rate significantly higher in patients without gross disease. Overall, the complete response rate was 57%. Three grade 3 late toxicities occurred with patients experiencing fibrosis, infection, and lymphedema. The lone grade 4 event, dermatitis, occurred in a patient who had a cumulative RT dose of ≥120 Gy.[36]

Müller et al.[37] reviewed the data on the role of repeat surgery and chest wall reirradiation for curative intent. Forty-two women had received an initial median dose of 54 Gy and after local recurrences received either surgery followed by chest wall reirradiation or chest wall reirradiation alone. The second course of RT was conventionally fractionated to a median dose of 60 Gy. The median interval between courses of RT was slightly longer than that reported by Wahl et al.,[36] 53 versus 38 months. At a median follow-up of 41 months, the estimated 5-year local control was 62% and 5-year OS was 59%. Only two cases of acute grade 3 skin toxicity were noted. Eight cases of late grade 3 skin toxicity were reported and no acute or late grade 4 toxicity occurred.[37]

Laramore et al.[38] reported a study on 13 patients treated with conventionally fractionated electrons for chest wall recurrences. All patients had received previous postoperative chest wall irradiation with doses between 40 and 50 Gy. Of these patients, 62% were alive and free of local disease after a median follow-up of 12 months. Skin reactions were limited to temporary erythema and dry or moist desquamation.[38]

These studies indicate that chest wall reirradiation can provide an improved prognosis for women with local recurrence and can be administered with acceptable acute and late toxicities following initial treatment of breast cancer with surgery and postoperative RT. Simultaneous radiochemotherapy as a treatment option has been investigated in a limited number of trials.


  Reirradiation with or without Hyperthermia Top


Jones et al.[39] enrolled 109 patients with superficial tumors (70 patients with breast cancer) in a prospective randomized trial comparing irradiation of chest wall recurrences with irradiation and additional hyperthermia. The complete response rate was 66.1% in the hyperthermia and 42.3% in the irradiation-only arm. Previously irradiated patients had the greatest incremental gain in complete response: 23.5% in the non-hyperthermia versus 68.2% in the hyperthermia arm. No OS benefit was seen. The authors concluded that adjuvant hyperthermia resulted in a significant local control benefit in patients with superficial tumors receiving RT.[39] The data were supported by a meta-analysis of five randomized trials including 306 patients with advanced primary or recurrent breast cancer. The complete remission rate was significantly improved in patients treated with combined radiation and hyperthermia compared to radiation alone (59% vs. 41%). OS was not improved.[40]

More recent data were published in a retrospective analysis of 198 patients who underwent either R0 (n = 107) or R1 resection (n = 91) for recurrent breast cancer. Hyperthermia was used as an adjunct to reirradiation (eight 4-Gy fractions). After a median follow-up of 42 months, the 5-year locoregional control rate was 78%. The 5-year grade 3/4 late toxicity rate amounted to 11.9% (n = 15 skin ulcerations, n = 5 osteoradionecrosis of the ribs). The same working group investigated 248 patients with a macroscopic breast cancer recurrence treated with reirradiation and hyperthermia. After a median follow-up of 32 months, 70% of patients had a complete remission. The 5-year local control rate was 39%. Thermal burn was developed by 23% of patients, which healed with conservative measures. The incidence of 5-year late grade 3 toxicity was 1%.[41]


  Contouring Guidelines for Partial Breast Reirradiation After Repeat BCS for IBTR (Adopted from RTOG 1014) Top


The excision cavity should be outlined based either on clear visualization on CT or, if placed, with the help of surgical clips. The clinical target volume (CTV) should be defined by uniformly expanding the excision cavity volume by 15mm. The CTV should be limited to 5mm from the skin surface and by the posterior breast tissue extent (chest wall structures and pectoralis muscles are not to be included). The planning target volume (PTV) should provide a margin around the CTV to compensate for the variability of treatment setup and motion of the breast with breathing. The PTV should be defined as a minimum of 10mm around the CTV (superior, inferior, medial, and lateral dimension) to account for anticipated breathing motion and setup uncertainty.

The PTV is saved and is used to generate the beam aperture (with an additional margin to take penumbra into account). PTV for Evaluation (PTV_EVAL) is generated for dose volume histogram (DVH) constraints and analysis as substantial part of the PTV often extends outside the limits of breast tissue an additional contour. PTV_EVAL is limited to exclude the part outside the ipsilateral breast and the first 5mm of tissue under the skin (to remove most of the buildup region for the DVH analysis) and to exclude the PTV expansion beyond the posterior extent of breast tissue (chest wall, pectoralis muscles, and lung). This PTV_EVAL should not be used for beam aperture generation.


  Roleof Systemic Therapyin Isolated Local Breast Cancer Recurrence Top


Various National Surgical Adjuvant Breast and Bowel Project protocols showed a higher risk of distant metastases and an increase in mortality rates following ipsilateral locoregional recurrence. But in view of inadequate evidence, the role of chemotherapy is still controversial. The CALOR (Chemotherapy as Adjuvant for Locally Recurrent breast cancer) study is a randomized trial that randomized patients into no chemotherapy or investigator’s choice of four cycles of chemotherapy. Patients with estrogen receptor (ER) positive disease received adjuvant therapy, and anti-human epidermal growth factor receptor 2 (HER2) therapy was optional. At a median follow-up of 4.9 years, the disease-free survival was better in chemotherapy arm. However, patients with ER-negative disease benefited most with adjuvant chemotherapy. But with slow accrual and less number of patients recruited than the intended sample size (162 of 1000 patients), it is difficult to interpret the conclusions.[42] Adjuvant hormonal therapy is recommended in all patients with hormone-positive tumors, irrespective of administration of chemotherapy. Patients who are premenopausal are treated with tamoxifen and switched over to aromatase inhibitors if they are postmenopausal or had ovarian ablation. Trastuzumab or lapatinib can be used in HER2-positive disease.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Sedlmayer F, Sautter-Bihl ML, Budach W, Dunst J, Fastner G, Feyer P, et al.; Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO). DEGRO practical guidelines: Radiotherapy of breast cancer I: Radiotherapy following breast conserving therapy for invasive breast cancer. Strahlenther Onkol 2013;189:825-33.  Back to cited text no. 1
    
2.
Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233-41.  Back to cited text no. 2
    
3.
Wapnir IL, Anderson SJ, Mamounas EP, Geyer CE Jr, Jeong JH, Tan-Chiu E, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five national surgical adjuvant breast and bowel project node-positive adjuvant breast cancer trials. J Clin Oncol 2006;24:2028-37.  Back to cited text no. 3
    
4.
Bouganim M, Tsetkova E, Clemons M, Amir E. Evolution of sites of recurrence after early breast cancer over the last 20 years: Implications for patient care and future research. Breast Cancer Res Treat 2013;139:603-6.  Back to cited text no. 4
    
5.
Fastner G, Hauser-Kronberger C, Moder A, Reitsamer R, Zehentmayr F, Kopp P, et al. Survival and local control rates of triple-negative breast cancer patients treated with boost-IOERT during breast-conserving surgery. Strahlenther Onkol 2016;192:1-7.  Back to cited text no. 5
    
6.
Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: Meta-analysis of individual patient data for 10801 women in 17 randomised trials. Lancet 2011;378:1707-16.  Back to cited text no. 6
    
7.
Kamby C, Sengeløv L. Pattern of dissemination and survival following isolated locoregional recurrence of breast cancer. A prospective study with more than 10 years of follow up. Breast Cancer Res Treat 1997;45:181-92.  Back to cited text no. 7
    
8.
Dunst J, Steil B, Furch S, Fach A, Lautenschläger C, Diestelhorst A, et al. Prognostic significance of local recurrence in breast cancer after postmastectomy radiotherapy. Strahlenther Onkol 2001;177:504-10.  Back to cited text no. 8
    
9.
Willner J, Kiricuta IC, Kölbl O. Locoregional recurrence of breast cancer following mastectomy: Always a fatal event? Results of univariate and multivariate analysis. Int J Radiat Oncol Biol Phys 1997;37:853-63.  Back to cited text no. 9
    
10.
Salvadori B, Marubini E, Miceli R, Conti AR, Cusumano F, Andreola S, et al. Reoperation for locally recurrent breast cancer in patients previously treated with conservative surgery. Br J Surg 1999;86:84-7.  Back to cited text no. 10
    
11.
Dalberg K, Mattsson A, Sandelin K, Rutqvist LE. Outcome of treatment for ipsilateral breast tumor recurrence in early-stage breast cancer. Breast Cancer Res Treat 1998;49:69-78.  Back to cited text no. 11
    
12.
Cajucom CC, Tsangaris TN, Nemoto T, Driscoll D, Penetrante RB, Holyoke ED. Results of salvage mastectomy for local recurrence after breast-conserving surgery without radiation therapy. Cancer 1993;71:1774-9.  Back to cited text no. 12
    
13.
Recht A, Schnitt SJ, Connolly JL, Mary Ann Rose, Barbara Silver, Steven Come, et al. Prognosis following local or regional recurrence after conservative surgery and radiotherapy for early stage breast carcinoma. Int J Radiat Oncol Biol Phys 1989;16:3-9.  Back to cited text no. 13
    
14.
Osborne MP, Borgen PI, Wong GY, Rosen PP, McCormick B, Salvage mastectomy for local and regional recurrence after breast-conserving operation and radiation therapy. Surg Gynecol Obstet 1992;174:189-94.  Back to cited text no. 14
    
15.
Fisher B, Anderson S, Fisher ER, Redmond C, Wickerham DL, Wolmark N, et al. Significance of ipsilateral breast tumour recurrence after lumpectomy. Lancet 1991;338:327-31.  Back to cited text no. 15
    
16.
Bloomer WD, LaCombe MA, Winchester DJ, Winchester DP, Hudis CA.Breast Cancer: Breast cancer in the irradiated breast.Hamilton Ontario: Second. BC Decker Inc; 2006. p. 448.  Back to cited text no. 16
    
17.
Harms W, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, et al. DEGRO practical guidelines for radiotherapy of breast cancer VI: Therapy of locoregional breast cancer recurrences. Strahlenther Onkol 2016;192:199-208.  Back to cited text no. 17
    
18.
Moy L, Newell MS, Mahoney MC, Bailey L, Barke LD, Carkaci S, et al. ACR appropriateness criteria stage I breast cancer: Initial workup and surveillance for local recurrence and distant metastases in asymptomatic women. J Am Coll Radiol 2016;13:e43-52.  Back to cited text no. 18
    
19.
Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, et al. American Cancer Society/American Society Of Clinical Oncology breast cancer survivorship care guideline. CA Cancer J Clin 2016;66:43-73.  Back to cited text no. 19
    
20.
Network (NCCN) NCC. Clinical Practice Guidelines in Oncology-Breast Cancer, Version 2. 2011. [Internet]. Available from: https://ci.nii.ac.jp/naid/20001233075/. [Last accessed on 2018 Oct 29.]  Back to cited text no. 20
    
21.
Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. Oxford Academic [Internet]. Available from: https://academic.oup.com/annonc/article/26/suppl_5/v8/344805. [Last accessed on 2018 Oct 29.]  Back to cited text no. 21
    
22.
Sia J, Moodie K, Bressel M, Lau E, Gyorki D, Skandarajah A, et al. A prospective study comparing digital breast tomosynthesis with digital mammography in surveillance after breast cancer treatment. Eur J Cancer 2016;61:122-7.  Back to cited text no. 22
    
23.
Metzger-Filho O, Sun Z, Viale G, Price KN, Crivellari D, Snyder RD, et al. Patterns of recurrence and outcome according to breast cancer subtypes in lymph node-negative disease: Results from international breast cancer study group trials VIII and IX. J Clin Oncol 2013;31:3083-90.  Back to cited text no. 23
    
24.
Deutsch M. Repeat high-dose external beam irradiation for in-breast tumor recurrence after previous lumpectomy and whole breast irradiation. Int J Radiat Oncol Biol Phys 2002;53:687-91.  Back to cited text no. 24
    
25.
Würschmidt F, Dahle J, Petersen C, Wenzel C, Kretschmer M, Bastian C. Reirradiation of recurrent breast cancer with and without concurrent chemotherapy. Radiat Oncol 2008;3:28.  Back to cited text no. 25
    
26.
Douglas WA, Winter KA, Kuerer HM, Haffty BG, Cuttino LW, Todor DA, et al. NRG Oncology–Radiation Therapy Oncology Group Study 1014: 1-Year Toxicity Report from a phase 2 study of repeat breast-preserving surgery and 3-dimensional conformal partial-breast reirradiation for in-breast recurrence. Int J Radiat Oncol Biol Phys 2017;98:1028-35.  Back to cited text no. 26
    
27.
Kraus-Tiefenbacher U, Bauer L, Scheda A, Schoeber C, Schaefer J, Steil V, et al. Intraoperative radiotherapy (IORT) is an option for patients with localized breast recurrences after previous external-beam radiotherapy. BMC Cancer 2007;7:178.  Back to cited text no. 27
    
28.
Hannoun-Levi JM, Resch A, Gal J, Kauer-Dorner D, Strnad V, Niehoff P, et al.; GEC-ESTRO Breast Cancer Working Group. Accelerated partial breast irradiation with interstitial brachytherapy as second conservative treatment for ipsilateral breast tumour recurrence: Multicentric study of the GEC-ESTRO breast cancer working group. Radiother Oncol 2013;108:226-31.  Back to cited text no. 28
    
29.
Resch A, Fellner C, Mock U, Handl-Zeller L, Biber E, Seitz W, et al. Locally recurrent breast cancer: Pulse dose rate brachytherapy for repeat irradiation following lumpectomy—A second chance to preserve the breast. Radiology 2002;225:713-8.  Back to cited text no. 29
    
30.
Kauer-Dorner D, Pötter R, Resch A, Handl-Zeller L, Kirchheiner K, Meyer-Schell K, et al. Partial breast irradiation for locally recurrent breast cancer within a second breast conserving treatment: Alternative to mastectomy? Results from a prospective trial. Radiother Oncol 2012;102:96-101.  Back to cited text no. 30
    
31.
Chadha M, Feldman S, Boolbol S, Wang L, Harrison LB. The feasibility of a second lumpectomy and breast brachytherapy for localized cancer in a breast previously treated with lumpectomy and radiation therapy for breast cancer. Brachytherapy 2008;7:22-8.  Back to cited text no. 31
    
32.
Trombetta M, Julian T, Bhandari T, Werts ED, Miften M, Parda D. Breast conservation surgery and interstitial brachytherapy in the management of locally recurrent carcinoma of the breast: The Allegheny General Hospital experience. Brachytherapy 2008;7:29-36.  Back to cited text no. 32
    
33.
Chadha M, Trombetta M, Boolbol S, Osborne MP. Managing a small recurrence in the previously irradiated breast. Is there a second chance for breast conservation? Oncology (Williston Park) 2009;23:933-40.  Back to cited text no. 33
    
34.
Guix B, Lejárcegui JA, Tello JI, Zanón G, Henríquez I, Finestres F, et al. Exeresis and brachytherapy as salvage treatment for local recurrence after conservative treatment for breast cancer: Results of a ten-year pilot study. Int J Radiat Oncol Biol Phys 2010;78:804-10.  Back to cited text no. 34
    
35.
Dahlstrøm KK, Andersson AP, Andersen M, Krag C. Wide local excision of recurrent breast cancer in the thoracic wall. Cancer 1993;72:774-7.  Back to cited text no. 35
    
36.
Wahl AO, Rademaker A, Kiel KD, Jones EL, Marks LB, Croog V, et al. Multi-institutional review of repeat irradiation of chest wall and breast for recurrent breast cancer. Int J Radiat Oncol Biol Phys 2008;70:477-84.  Back to cited text no. 36
    
37.
Müller AC, Eckert F, Heinrich V, Bamberg M, Brucker S, Hehr T. Re-surgery and chest wall re-irradiation for recurrent breast cancer: A second curative approach. BMC Cancer 2011;11:197.  Back to cited text no. 37
    
38.
Laramore GE, Griffin TW, Parker RG, Gerdes AJ. The use of electron beams in treating local recurrence of breast cancer in previously irradiated fields. Cancer 1978;41:991-5.  Back to cited text no. 38
    
39.
Jones EL, Oleson JR, Prosnitz LR, Samulski TV, Vujaskovic Z, Yu D, et al. Randomized trial of hyperthermia and radiation for superficial tumors. J Clin Oncol 2005;23:3079-85.  Back to cited text no. 39
    
40.
Vernon CC, Hand JW, Field SB, Machin D, Whaley JB, van der Zee J, et al. Radiotherapy with or without hyperthermia in the treatment of superficial localized breast cancer: Results from five randomized controlled trials. International collaborative hyperthermia group. Int J Radiat Oncol Biol Phys 1996;35:731-44.  Back to cited text no. 40
    
41.
Linthorst M, Baaijens M, Wiggenraad R, Creutzberg C, Ghidey W, van Rhoon GC, et al. Local control rate after the combination of re-irradiation and hyperthermia for irresectable recurrent breast cancer: Results in 248 patients. Radiother Oncol 2015;117:217-22.  Back to cited text no. 41
    
42.
Aebi S, Gelber S, Anderson SJ, Láng I, Robidoux A, Martín M, et al.; CALOR investigators. Chemotherapy for isolated locoregional recurrence of breast cancer (CALOR): A randomised trial. Lancet Oncol 2014;15:156-63.  Back to cited text no. 42
    




 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Imaging Modaliti...
Second Breast-Co...
Repeat Chest Wal...
Reirradiation wi...
Contouring Guide...
Roleof Systemic ...
References

 Article Access Statistics
    Viewed436    
    Printed51    
    Emailed0    
    PDF Downloaded73    
    Comments [Add]    

Recommend this journal