Breast Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_9_3405 - Management of loco-regional recurrent breast cancer after prior radiation to the breast or chest wall

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Management of loco-regional recurrent breast cancer after prior radiation to the breast or chest wall
Y. Korzets1,2, G. Lee2, S. Misra1,2, O. Espin-Garcia3, T. G. Purdie1,2, C. A. Koch1,2, A. Fyles1,2, and A. S. Barry2; 1Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada, 2Radiation Medicine Program, University Health Network and Princess Margaret Cancer Centre, Toronto, ON, Canada, 3Department of Biostatistics, Princess Margaret Cancer Centre, Toronto., Toronto, ON, Canada

Purpose/Objective(s): To report the outcomes of radiotherapy (RT) re-treatment to the breast or chest wall in women with loco-regional breast cancer recurrence.

Materials/Methods: Between 2009-2017, 55 women with clinically non-metastatic loco-regional recurrence of breast cancer were re-irradiated (reRT) with curative intent after repeat local surgery. Initial breast cancer diagnosis was between 1980-2013. Twenty-nine (53%) patients received re-RT to the chest wall (CW) or breast +/- regional nodes (25 to the CW, 3 to partial breast and 1 to partial CW), 26 received RT to the regional nodes alone. Documentation of initial breast cancer diagnosis, first recurrence and second recurrence (where applicable) were recorded. Median follow up from the initial diagnosis to first recurrence and then from first recurrence to last survival date was 10.3 (range, 6.6-14.4) and 4.1 (range, 0.3-9.8) years, respectively.

Results: At time of initial breast cancer diagnosis, the median age was 48 years (28-86), 46 (84%) patients had stage I-II disease, 6 (11%) were stage III and 3 (5%) had carcinoma in-situ. Forty-eight (87%) underwent lumpectomy and 7 (13%) had mastectomy. All patients received radiation to the breast/CW and 8 to the regional lymph nodes. First recurrence: 23 (42%) patients had regional nodal recurrence (axillary, supraclavicular or internal mammary), 19 (34%) had local breast/CW recurrence and 13 (24%) had simultaneous loco-regional recurrence. The most frequently used re-treatment dose was 45 Gy in 25 fractions (68%) for CW recurrence and 50 Gy in 25 fractions (71%) for nodal recurrence. Thirty-two (58%) patients received chemotherapy, half in the adjuvant setting, and half in the neo-adjuvant setting, 35 (64%) patients had endocrine treatment and 16 (29%) had both. Five- year survival rates for regional, local and simultaneous loco-regional recurrences were 93%, 86% and 73%, respectively (p-value= 0.148). Overall survival rates at 5 and 8-years for the entire cohort were 86% and 63%, respectively. Recurrence after retreatment: Eight (15%) patients had a subsequent breast cancer recurrence, with a median time of 1.6 (range, 0.6-6.1) years. Only 9 patient had grade 2 or more toxicity recorded (fibrosis (4), lymphedema (2), fat atrophy (1), brachial plexopathy and hyperpigmentation (1), skin ulceration (1)).

Conclusion: Aggressive management of loco-regional breast cancer recurrences with surgery and repeat radiation is feasible with tolerable toxicity and good outcomes.

Author Disclosure: Y. Korzets: None. G. Lee: None. S. Misra: None. O. Espin-Garcia: None. T.G. Purdie: None. C.A. Koch: None.

Christine Koch, MD, PhD

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