Reirradiation as a Component of the Multidisciplinary Management of Locally Recurrent Breast Cancer

Background and PurposeOur intent was to review a modern multidisciplinary institutional experience involving reirradiation of the breast, chest wall, and lymphatics for locoregional recurrences of breast cancer and report toxicity and clinical outcomes.Materials and MethodsBetween 1995 and 2009, 12 locoregional recurrences were reirradiated in 8 patients. The mean dose of initial radiotherapy was 57.1 Gy (range, 50.4-60.6 Gy), and the mean dose of reirradiation was 46.7 Gy (range, 30-62.1 Gy). The second course of radiotherapy was delivered using daily radiotherapy to 5 recurrences, twice-daily radiotherapy to 5 recurrences (1 with mold brachytherapy boost), and a combination of once- and twice-daily radiotherapy to 2 recurrences.ResultsThe median follow-up from time of completion of reirradiation was 30 months (range, 1.5-67 months). Local control was achieved in 7 of 8 patients and 11 of 12 recurrences. Regional control was achieved in 5 of 8 patients and 6 of 12 recurrences. Distant control was achieved in 5 of 8 patients. At time of analysis, 5 of 8 patients were alive. Median survival since reirradiation completion was 36 months (range, 4.5-47 months). Acute toxicity included grade 2 dermatitis in 4 patients, ipsilateral shoulder pain in 1 patient, and ipsilateral pleurisy in 1 patient. Late skin and soft tissue toxicity manifested as fibrosis in 4 patients, hyperpigmentation in 3 patients, and telangiectasia in 3 patients. Three patients reported lymphedema, 1 patient reporting chest wall pain and 1 patient with an ipsilateral rib fracture.ConclusionsMultidisciplinary management of locoregional recurrence of breast cancer using reirradiation is well tolerated as salvage treatment and provides durable locoregional control.