Re-irradiation for locally recurrent refractory breast cancer

// Tomas Merino 1,2,3 , William T. Tran 1 and Gregory J. Czarnota 1,2 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada 2 Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada 3 Departamento de Hemato-Oncologia, Pontificia Universidad Catolica de Chile, Santiago, Chile Correspondence to: Gregory J. Czarnota, email: // Keywords : breast cancer, radiotherapy, re-irradiation, recurrent, refractory breast cancer Received : May 25, 2015 Accepted : August 31, 2015 Published : October 08, 2015 Abstract Purpose: To report an analysis of treatment outcomes of a cohort of patients re-irradiated for locally recurrent refractory breast cancer (LRRBC) Patients and Methods: Between 2008 and 2013, 47 women (mean age = 60 years) were re-irradiated for LRRBC. Outcomes were measured using Kaplan-Meier log rank to compare curves and Cox regression for multivariate analysis. Outcomes included overall survival (OS), time to re-treatment, survival without systemic progression, and survival without local recurrence. Results: Fifty-six instances of re-irradiation were completed and analyzed. The mean cumulative 2 Gy equivalent dose (EQD2) to the whole breast and tumour cavity (α/β = 3) was 99.8 Gy and 109.1 Gy, respectively. Most patients initially had significant symptoms before RT due to local recurrence. The median time to re-treatment and to systemic failure was 41 and 50 months, respectively. Median follow-up for OS was 17 months and OS was 0.73 (SE = 0.07) at 1 year and 0.67 (SE = 0.07) at 2 years. Local control was 0.62 (SE = 0.07) and 0.5 (0.08) at 1 and 2 years, respectively. Acute radiation dermatitis was G1-2, G3 and G4 in 45, 4 and 1 cases, respectively. One patient presented with necrosis. The most common long term toxicity was G3 fibrosis ( n = 4) and telangiectatic changes ( n = 3). Multivariable analysis indicated that skin involvement (Hazard Ratio = 6.6 (1.4-31), p = 0.016) and time to local recurrence <2yr (HR 3.1 (1.04-9.7) p = 0.042) predicted local recurrence. Conclusion: High dose re-irradiation is feasible for locally RRBC. This approach can have a significant benefit in this very high-risk group.