Radiotherapy in the treatment of ipsilateral breast tumor recurrence (IBTR) following breast conservation

Abstract
Purpose: To provide an overview of the state of retreatment irradiation in the management of patients who develop ipsilateral breast tumor recurrence (IBTR). Materials and methods: We reviewed the modern literature and correlated it with our extensive experience in retreatment of the breast in patients originally treated with lumpectomy and post-operative irradiation following IBTR. We report the updated results of our patients treated by low dose rate temporary interstitial implant (LDR), high dose rate (HDR) balloon brachytherapy, and three dimensional conformal radiotherapy (3-D CRT), and compare these to results reported by other authors. Results: A total of 42 patients have been treated on our protocol. With a mean follow up of 67.5 months (range 5-115 months), twenty-one of 22 LDR patients achieved local control at the time of last follow-up, or at the time of their death. The single patient who developed a second local recurrence was treated successfully with mastectomy. One of 15 HDR patients developed an inflammatory recurrence and was successfully treated by salvage mastectomy. All five 3-D CRT patients have retained their breasts. Two LDR patients developed localized skin breakdown. Five of 42 patients have expired with 3/5 succumbing to metastatic breast cancer. One patient died from chronic obstructive pulmonary disease, and one died from cardiac complications secondary to previous mantle radiotherapy. One patient developed a contralateral breast cancer. Long-term cosmetic results as defined by the Harvard cosmesis scale and the Allegheny General (AGH) modification were acceptable, and the AGH modification more accurately reported cosmetic changes. Conclusions: These long-term data suggest that repeat lumpectomy followed by repeat post-operative radiotherapy is feasible and may be an acceptable alternative to salvage mastectomy in patients who develop IBTR following conservation breast therapy. An improved cosmetic reporting system (the AGH modification) is required to more accurately identify post-retreatment cosmesis.

Key words
breast cancer, ipsilateral breast tumor recurrence, radiotherapy, breast conservation

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Bibliografía del artículo
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