Multi-Institutional Review of Repeat Irradiation of Chest Wall and Breast for Recurrent Breast Cancer

Andrew O. Wahl, Alfred Rademaker, Krystyna D. Kiel, Ellen L. Jones, Lawrence B. Marks, Victoria Croog, Beryl M. McCormick, Arica Hirsch, Ami Karkar, Sabin B. Motwani, Welela Tereffe, Tse Kuan Yu, David Sher, Joshua Silverstein, Lisa A. Kachnic, Christy Kesslering, Gary M. Freedman, William Small

Research output: Contribution to journalArticle

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Abstract

Purpose: To review the toxicity and clinical outcomes for patients who underwent repeat chest wall or breast irradiation (RT) after local recurrence. Methods and Materials: Between 1993 and 2005, 81 patients underwent repeat RT of the breast or chest wall for locally recurrent breast cancer at eight institutions. The median dose of the first course of RT was 60 Gy and was 48 Gy for the second course. The median total radiation dose was 106 Gy (range, 74.4-137.5 Gy). At the second RT course, 20% received twice-daily RT, 54% were treated with concurrent hyperthermia, and 54% received concurrent chemotherapy. Results: The median follow-up from the second RT course was 12 months (range, 1-144 months). Four patients developed late Grade 3 or 4 toxicity. However, 25 patients had follow-up >20 months, and no late Grade 3 or 4 toxicities were noted. No treatment-related deaths occurred. The development of Grade 3 or 4 late toxicity was not associated with any repeat RT variables. The overall complete response rate was 57%. No repeat RT parameters were associated with an improved complete response rate, although a trend was noted for an improved complete response with the addition of hyperthermia that was close to reaching statistical significance (67% vs. 39%, p = 0.08). The 1-year local disease-free survival rate for patients with gross disease was 53% compared with 100% for those without gross disease (p < 0.0001). Conclusions: The results of our study have shown that repeat RT of the chest wall for patients with locally recurrent breast cancer is feasible, because it is associated with acceptable acute and late morbidity and encouraging local response rates.

Original languageEnglish (US)
Pages (from-to)477-484
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume70
Issue number2
DOIs
StatePublished - Feb 1 2008

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chest
Thoracic Wall
breast
Breast
cancer
Breast Neoplasms
toxicity
irradiation
grade
hyperthermia
Fever
dosage
chemotherapy
death
Disease-Free Survival
Survival Rate
Radiation
Morbidity
trends
Recurrence

Keywords

  • Breast cancer
  • Hyperthermia
  • Local recurrence
  • Radiotherapy
  • Repeat irradiation
  • Toxicity

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Multi-Institutional Review of Repeat Irradiation of Chest Wall and Breast for Recurrent Breast Cancer. / Wahl, Andrew O.; Rademaker, Alfred; Kiel, Krystyna D.; Jones, Ellen L.; Marks, Lawrence B.; Croog, Victoria; McCormick, Beryl M.; Hirsch, Arica; Karkar, Ami; Motwani, Sabin B.; Tereffe, Welela; Yu, Tse Kuan; Sher, David; Silverstein, Joshua; Kachnic, Lisa A.; Kesslering, Christy; Freedman, Gary M.; Small, William.

In: International Journal of Radiation Oncology Biology Physics, Vol. 70, No. 2, 01.02.2008, p. 477-484.

Research output: Contribution to journalArticle

Wahl, AO, Rademaker, A, Kiel, KD, Jones, EL, Marks, LB, Croog, V, McCormick, BM, Hirsch, A, Karkar, A, Motwani, SB, Tereffe, W, Yu, TK, Sher, D, Silverstein, J, Kachnic, LA, Kesslering, C, Freedman, GM & Small, W 2008, 'Multi-Institutional Review of Repeat Irradiation of Chest Wall and Breast for Recurrent Breast Cancer', International Journal of Radiation Oncology Biology Physics, vol. 70, no. 2, pp. 477-484. https://doi.org/10.1016/j.ijrobp.2007.06.035
Wahl, Andrew O. ; Rademaker, Alfred ; Kiel, Krystyna D. ; Jones, Ellen L. ; Marks, Lawrence B. ; Croog, Victoria ; McCormick, Beryl M. ; Hirsch, Arica ; Karkar, Ami ; Motwani, Sabin B. ; Tereffe, Welela ; Yu, Tse Kuan ; Sher, David ; Silverstein, Joshua ; Kachnic, Lisa A. ; Kesslering, Christy ; Freedman, Gary M. ; Small, William. / Multi-Institutional Review of Repeat Irradiation of Chest Wall and Breast for Recurrent Breast Cancer. In: International Journal of Radiation Oncology Biology Physics. 2008 ; Vol. 70, No. 2. pp. 477-484.
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AU - Croog, Victoria

AU - McCormick, Beryl M.

AU - Hirsch, Arica

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AU - Motwani, Sabin B.

AU - Tereffe, Welela

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N2 - Purpose: To review the toxicity and clinical outcomes for patients who underwent repeat chest wall or breast irradiation (RT) after local recurrence. Methods and Materials: Between 1993 and 2005, 81 patients underwent repeat RT of the breast or chest wall for locally recurrent breast cancer at eight institutions. The median dose of the first course of RT was 60 Gy and was 48 Gy for the second course. The median total radiation dose was 106 Gy (range, 74.4-137.5 Gy). At the second RT course, 20% received twice-daily RT, 54% were treated with concurrent hyperthermia, and 54% received concurrent chemotherapy. Results: The median follow-up from the second RT course was 12 months (range, 1-144 months). Four patients developed late Grade 3 or 4 toxicity. However, 25 patients had follow-up >20 months, and no late Grade 3 or 4 toxicities were noted. No treatment-related deaths occurred. The development of Grade 3 or 4 late toxicity was not associated with any repeat RT variables. The overall complete response rate was 57%. No repeat RT parameters were associated with an improved complete response rate, although a trend was noted for an improved complete response with the addition of hyperthermia that was close to reaching statistical significance (67% vs. 39%, p = 0.08). The 1-year local disease-free survival rate for patients with gross disease was 53% compared with 100% for those without gross disease (p < 0.0001). Conclusions: The results of our study have shown that repeat RT of the chest wall for patients with locally recurrent breast cancer is feasible, because it is associated with acceptable acute and late morbidity and encouraging local response rates.

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