Intraoperative radiotherapy (IORT) is an option for patients with localized breast recurrences after previous external-beam radiotherapy

Uta Kraus-Tiefenbacher, Lelia Bauer, Antonella Scheda, Carola Schoeber, Joerg Schaefer, Volker Steil, Frederik Wenz, Uta Kraus-Tiefenbacher, Lelia Bauer, Antonella Scheda, Carola Schoeber, Joerg Schaefer, Volker Steil, Frederik Wenz

Abstract

Background: For patients suffering of recurrent breast cancer within the irradiated breast, generally mastectomy is recommended. The normal tissue tolerance does not permit a second full-dose course of radiotherapy to the entire breast after a second breast-conserving surgery (BCS). A novel option is to treat these patients with partial breast irradiation (PBI). This approach is based on the hypothesis that re-irradiation of a limited volume will be effective and result in an acceptable frequency of side effects. The following report presents a single center experience with intraoperative radiotherapy (IORT) during excision of recurrent breast cancer in the previously irradiated breast.

Methods: Between 4/02 and 11/06, 15 patients were treated for in-breast recurrences at a median of 10 years (3-25) after previous EBRT (10 recurrences in the initial tumor bed, 3 elsewhere in-breast failures, 2 invasive recurrences after previous DCIS). Additional 2 patients were selected for IORT with new primary breast cancer after previous partial breast EBRT for treatment of Hodgkin's disease. IORT with a single dose of 14.7 - 20 Gy 50 kV X-rays at the applicator surface was delivered with the Intrabeam-device (Carl Zeiss, Oberkochen, Germany).

Results: After a median follow-up of 26 months (1-60), no local recurrence occurred. 14 out of 17 patients are alive and free of disease progression. Two patients are alive with distant metastases. One patient died 26 months after BCS/IORT due to pulmonary metastases diagnosed 19 months after BCS/IORT. Acute toxicity after IORT was mild with no Grade 3/4 toxicities and cosmetic outcome showed excellent/good/fair results in 7/7/3 cases.

Conclusion: IORT for recurrent breast cancer using low energy X-rays is a valuable option for patients with recurrent breast cancer after previous radiotherapy.

Figures

Figure 1
Figure 1
Breast-ultrasound for routine follow-up of a patient (no.17, 16 years after primary breast cancer) showed a small hypoechogeneity within the previous index quadrant.
Figure 2
Figure 2
Craniocaudal mammography of the same patient with a small dense structure suspicious for recurrent breast cancer. This non-palpable lesion was marked by a wire before surgery.
Figure 3
Figure 3
Oblique mammography of the same patient.

References

    1. Veronesi U, Marubini E, Mariani L. Radiotherapy after breast-conserving surgery in small breast carcinoma:long-term results of a randomized trial. Ann Oncol. 2002;12:997–1003. doi: 10.1023/A:1011136326943.
    1. Vinh-Hung V, Verschraegen C. Breast-conserving surgery with or without radiotherapy: pooled analysis for risks of ipsilateral breast tumour recurrence and mortality. J Natl Cancer Inst. 2004;96:115–121.
    1. Fisher B, Anderson S, Bryant J. 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;347:1233–1241. doi: 10.1056/NEJMoa022152.
    1. Veronesi U, Cascinelli N, Mariani L. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–1232. doi: 10.1056/NEJMoa020989.
    1. Bartelink H, Horiot JC, Poortmans P. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med. 2001;345:1378–1387. doi: 10.1056/NEJMoa010874.
    1. Romestaing P, Lehingue Y, Carrie C. Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France. J Clin Oncol. 1997;15:963–968.
    1. Fisher B, Anderson S, Fisher ER. Significance of ipsilateral breast tumour recurrence after lumpectomy. Lancet. 1991;338:327–331. doi: 10.1016/0140-6736(91)90475-5.
    1. Fisher ER, Sass R, Fisher B. Pathologic findings from the National Surgical Adjuvant Breast Project (protocol 6): II. Relation of local breast recurrence to multicentricity. Cancer. 1986;57:1717–1724. doi: 10.1002/1097-0142(19860501)57:9<1717::AID-CNCR2820570902>;2-H.
    1. Frediksson I, Liljergren G, Arnesson L. Local recurrence in the breast after conservative surgery: A study of prognosis and prognostic factors in 391 women. Eur J Cancer. 2002;38:1860–1870. doi: 10.1016/S0959-8049(02)00219-8.
    1. Veronesi U, Orrechia R, Luini A. Focalised intraoperative irradiation after conservative surgery for early stage breast cancer. BrJ Surg. 2001;10:84–89.
    1. Vaidya JS, Tobias JS, Baum M. TARGeted Intraoperative radioTherapy (TARGIT): An innovative approach to partial-breast irradiation. Sem Rad Oncol. 2005;15:84–91. doi: 10.1016/j.semradonc.2004.10.007.
    1. Kraus-Tiefenbacher U, Steil V, Bauer L. A novel mobile device for intraoperative radiotherapy (IORT) Onkologie. 2003;26:596–598. doi: 10.1159/000074158.
    1. Vaidya JS, Tobias J, Baum M. Intraoperative radiotherapy: the debate continues. Lancet Oncol. 2004;5:339–340. doi: 10.1016/S1470-2045(04)01488-3.
    1. Herskind C, Steil V, Tiefenbacher U. Radiobiologic aspects of intraoperative radiotherapy (IORT) with isotropic low-energy X-rays for early-stage breast cancer. Radiat Res. 2005;163:208–215. doi: 10.1667/RR3292.
    1. Kraus-Tiefenbacher U, Scheda A, Steil V. Intraoperative radiotherapy (IORT) for breast cancer using the INTRABEAM system. Tumori. 2005;91:339–345.
    1. Kraus-Tiefenbacher U, Bauer L, Scheda A, Fleckenstein K, Keller A, Herskind C, Steil V, Melchert F, Wenz F. Long-term toxicity of an intraoperative radiotherapy (IORT) boost using low energy X-rays during breast conserving surgery (BCS) Int J Radiat Oncol Biol Phys. 2006;66:377–381.
    1. Kuerer HM, Arthur DW, Haffty BG. Repeat breast-conserving surgery for in-breast local breast carcinoma recurrence: The potential role of partial breast irradiation. Cancer. 2004;100:2269–2280. doi: 10.1002/cncr.20257.
    1. Wapnir I, Anderson SJ, Mamounas EP. 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;13:2028–2036. doi: 10.1200/JCO.2005.04.3273.
    1. Moran MS, Haffty BG. Local-regional breast cancer recurrence: Prognostic groups based on patterns of failure. Breast J. 2002;8:81–87. doi: 10.1046/j.1524-4741.2002.08202.x.
    1. Kurtz JM, Amalric R, Brandone H. Results of wide excision for mammary recurrence after breast-conserving therapy. Cancer. 1988;61:1969–1972. doi: 10.1002/1097-0142(19880515)61:10<1969::AID-CNCR2820611006>;2-O.
    1. Kurtz JM, Jacquemier J, Amalric R. Is breast conservation after local recurrence feasible? Eur J Cancer. 1991;27:240–244.
    1. Mullen EE, Deutsch M, Bloomer WD. Salvage radiotherapy for local failure of lumpectomy and breast irradiation. Radiother Oncol. 1997;42:25–29. doi: 10.1016/S0167-8140(96)01864-6.
    1. Deutsch M. Repeat high-dose external beam irradiation for in-breast tumor recurrence after previous lumpectomy and whole breast irradiation. Int J Rad Oncol Biol Phys. 2002;53:687–691. doi: 10.1016/S0360-3016(02)02785-2.
    1. Hannoun-Levi JM, Houvenaeghel G, Ellis S. Partial breast irradiation as second conservative treatment for local breast cancer recurrence. Int J Rad Oncol Biol Phys. 2004;60:1385–1392. doi: 10.1016/j.ijrobp.2004.05.035.
    1. Borner M, Bacchi M, Godhirsch A. First isolated locoregional recurrence following mastectomy for breast cancer: Results of a phase III multicenter study comparing systemic treatment with observation after excsion and radiation- Swiss Group for Clinical Cancer Research. J Clin Oncol. 1994;12:2071–2077.
    1. Waeber M, Castiglione-Gertsch M, Dietrich B. Adjuvant therapy after excision and radiation of isolated postmastectomy locoregional breast cancer recurrence: Definitive results of a phase III randomized trial (SAKK 23/82) comparing tamoxifen with observation. Ann Oncol. 2003;13:1215–1221. doi: 10.1093/annonc/mdg347.
    1. Intra M, Leonardi MC, Gatti G, Vento AR, Ciocca M, Veronesi P, Bassani G, Dos Santos GR, Rodriguez J, Luini A, Orecchia R, Veronesi U. Intraoperative radiotherapy during breast conserving surgery in patients previously treated with radiotherapy for Hodgkin's disease. Tumor. 2004;90:13–16.
    1. Intra M, Gentilini O, Veronesi P, Ciocca M, Luini A, Lazzari R, Soteldo J, Farante G, Orecchia R, Veronesi U. A new option for early breast cancer patients previously irradiated for Hodgkin's diease: intraoperative radiotherapy with electrons (ELIOT) Breast Cancer Res. 2005;7:R828–832. doi: 10.1186/bcr1310.
    1. Deutsch M, Gerszten K, Bloomer WD, Avisar E. Lumpectomy and breast irradiation for breast cancer arising after previous radiotherapy for Hodgkin's disease or lymphoma. Am J Clin Oncol. 2001;24:33–34. doi: 10.1097/00000421-200102000-00005.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi