Second breast conserving therapy after ipsilateral breast tumor recurrence – a 10-year experience of re-irradiation

Tobias Forster; Sati Akbaba; Daniela Schmitt; David Krug; Rami El Shafie; Jan Oelmann-Avendano; Katja Lindel; Laila König; Nathalie Arians; Denise Bernhardt; Frederik Marmé; Andreas Schneeweiss; Jörg Heil; Christof Sohn; Jürgen Debus; Juliane Hörner-Rieber

doi:10.5114/jcb.2019.87001

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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abstract:

Original paper

Second breast conserving therapy after ipsilateral breast tumor recurrence – a 10-year experience of re-irradiation

Tobias Forster

^{1, 2, 3}

,

Sati Akbaba

^{1, 2, 3}

,

Daniela Schmitt

^{1, 2, 3}

,

David Krug

^{1, 4}

,

Rami El Shafie

^{1, 2, 3}

,

Jan Oelmann-Avendano

^{1, 2, 3}

,

Katja Lindel

⁵

,

Laila König

^{1, 2, 3}

,

Nathalie Arians

^{1, 2, 3}

,

Denise Bernhardt

^{1, 2, 3}

,

Frederik Marmé

^{6, 7}

,

Andreas Schneeweiss

^{3, 7}

,

Jörg Heil

^{6, 7}

,

Christof Sohn

⁶

,

Jürgen Debus

^{1, 2, 3, 8, 9, 10}

,

Juliane Hörner-Rieber

^{1, 2, 3, 8}

Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
National Center for Tumor Diseases (NCT), Heidelberg, Germany
Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
Department of Radiation Oncology, Municipal Hospital, Karlsruhe, Germany
Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
German Cancer Research Center (DKFZ), Heidelberg, Germany
Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
German Cancer Consortium (DKTK), partner site Heidelberg, Germany

J Contemp Brachytherapy 2019; 11, 4: 312–319

DOI: https://doi.org/10.5114/jcb.2019.87001

Online publish date: 2019/08/22

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AMA

Forster T, Akbaba S, Schmitt D, et al. Second breast conserving therapy after ipsilateral breast tumor recurrence – a 10-year experience of re-irradiation. Journal of Contemporary Brachytherapy. 2019;11(4):312-319. doi:10.5114/jcb.2019.87001.

APA

Forster, T., Akbaba, S., Schmitt, D., Krug, D., El Shafie, R.,  & Oelmann-Avendano, J. et al. (2019). Second breast conserving therapy after ipsilateral breast tumor recurrence – a 10-year experience of re-irradiation. Journal of Contemporary Brachytherapy, 11(4), 312-319. https://doi.org/10.5114/jcb.2019.87001

Chicago

Forster, Tobias, Sati Akbaba, Daniela Schmitt, David Krug, Rami El Shafie, Jan Oelmann-Avendano,  and Katja Lindel et al. 2019. "Second breast conserving therapy after ipsilateral breast tumor recurrence – a 10-year experience of re-irradiation". Journal of Contemporary Brachytherapy 11 (4): 312-319. doi:10.5114/jcb.2019.87001.

Harvard

Forster, T., Akbaba, S., Schmitt, D., Krug, D., El Shafie, R., Oelmann-Avendano, J., Lindel, K., König, L., Arians, N., Bernhardt, D., Marmé, F., Schneeweiss, A., Heil, J., Sohn, C., Debus, J.,  and Hörner-Rieber, J. (2019). Second breast conserving therapy after ipsilateral breast tumor recurrence – a 10-year experience of re-irradiation. Journal of Contemporary Brachytherapy, 11(4), pp.312-319. https://doi.org/10.5114/jcb.2019.87001

MLA

Forster, Tobias et al. "Second breast conserving therapy after ipsilateral breast tumor recurrence – a 10-year experience of re-irradiation." Journal of Contemporary Brachytherapy, vol. 11, no. 4, 2019, pp. 312-319. doi:10.5114/jcb.2019.87001.

Vancouver

Forster T, Akbaba S, Schmitt D, Krug D, El Shafie R, Oelmann-Avendano J et al. Second breast conserving therapy after ipsilateral breast tumor recurrence – a 10-year experience of re-irradiation. Journal of Contemporary Brachytherapy. 2019;11(4):312-319. doi:10.5114/jcb.2019.87001.

Purpose
The aim of this study is to evaluate the efficacy and toxicity of post-operative partial breast re-irradiation with multi-catheter brachytherapy after second breast conserving therapy (BCT) in patients with small, low-risk ipsilateral breast tumor recurrence (IBTR).

Material and methods
Between 2008 and 2018, 19 consecutive patients with low-risk IBTR (max. rpT1 cN0 cM0, Her2 negative, preferably positive hormone receptor status) who refused mastectomy were treated with salvage lumpectomy, followed by post-operative partial breast re-irradiation with multi-catheter brachytherapy. Eight patients were irradiated using PDR brachytherapy (49.8-50.4 Gy in pulses of 0.5-0.7 Gy) and 11 patients using HDR brachytherapy (34.2 Gy in fractions of 3.8 Gy or 32 Gy in fractions of 4 Gy). All patients had undergone prior BCT for their primary tumor, followed by adjuvant whole breast radiotherapy. Local control (LC), locoregional control (LRC), overall survival (OS), disease-free survival (DFS) as well as toxicity were evaluated in the present study.

Results
After a median follow-up of 65 months following IBTR (18-120 months), only one second IBTR in 19 patients was diagnosed 77 months after re-irradiation, resulting in a LC rate of 100% at 5 years. DFS and OS rates were both 100% at 5 years following re-irradiation. Except for the above mentioned second IBTR, no regional or distant relapse was recorded. Regarding toxicity, 63% of patients developed adverse events (CTCAE grade ≤ 2), with fibrosis detected in 37% (7/19) of patients, necrosis in 11% (2/19), hyperpigmentation in 47% (9/19), and telangiectasia in 11% (2/19), respectively. No patient showed a high-grade (CTCAE grade ≥ 3) adverse event.

Conclusions
In case of small, low-risk IBTR, adjuvant re-irradiation using multi-catheter brachytherapy is a feasible, safe, and effective treatment method after repeated lumpectomy, and an alternative to mastectomy.

keywords:

Second breast conserving therapy after ipsilateral breast tumor recurrence – a 10-year experience of re-irradiation

breast cancer, re-irradiation, brachytherapy, second breast conserving therapy, ipsilateral breast tumor recurrence