Patients with irresectable locoregional recurrent breast cancer en cuirasse (BCEC) do not have effective curative treatment options. Hyperthermia, the elevation of tumor temperature to 40-45 A... Show morePatients with irresectable locoregional recurrent breast cancer en cuirasse (BCEC) do not have effective curative treatment options. Hyperthermia, the elevation of tumor temperature to 40-45 A degrees C, is a well-established radio- and chemotherapy sensitizer. A total of 196 patients were treated with reirradiation and hyperthermia (reRT+HT) at two Dutch institutes from 1982-2005. The palliative effect was evaluated in terms of clinical outcome and toxicity.All patients received previous irradiation to a median dose of 50 Gy. In all, 75% of patients received 1-6 treatment modalities for previous tumor recurrences. ReRT consisted of 8 x 4 Gy given twice a week or 12 x 3 Gy given four times a week. Superficial hyperthermia was added once or twice a week. Tumor area comprised >= A 1/2 of the ipsilateral chest wall.Overall clinical response rate was 72% (complete response [CR] 30%, partial response [PR] 42%, stable disease [SD] 22%, progressive disease [PD] 6%). The local progression-free rate at 1 year was 24%. Median survival was 6.9 months. Forty-three percent of our patients with CR, PR, SD after treatment remained infield progression-free until death or last follow-up. Acute >= grade 3 toxicity occurred in 33% of patients, while late >= grade 3 toxicity was recorded in 14% of patients. Tumor ulceration prior to treatment had a negative impact on both clinical outcome and toxicity.ReRT+HT provides sustainable palliative tumor control, despite refractory, extensive tumor growth. Compared to currently available systemic treatment options, reRT+HT is more effective with less toxicity. Show less
Oldenborg, S.; Griesdoorn, V.; Os, R. van; Kusumanto, Y.H.; Oei, B.S.; Venselaar, J.L.; ... ; Tienhoven, G. van 2015
Background/purpose: Treatment options for irresectable locoregional recurrent breast cancer in previously irradiated area are limited. Hyperthermia, elevating tumor temperature to 40-45 degrees C,... Show moreBackground/purpose: Treatment options for irresectable locoregional recurrent breast cancer in previously irradiated area are limited. Hyperthermia, elevating tumor temperature to 40-45 degrees C, sensitizes radio-and-chemotherapy. Four hundred and fourteen patients treated with reirradiation + hyperthermia (reRT + HT) in the AMC((n=301)) and the BVI(n=113), from 1982 to 2005 were retrospectively analyzed for treatment response, locoregional control (LC) and prognostic factors for LC and toxicity.Patients/methods: All patients received previous irradiation (median 50 Gy). reRT consisted of 8 x 4 Gy-2/week (AMC) or 12 x 3 Gy-4/week (BVI). Hyperthermia was added once (AMC)/twice (BVI) a week.Results: Overall clinical response rate was 86%. The 3-year LC rate was 25%. The number of recurrence episodes, distant metastases (DM), tumor site, tumor size, time to recurrence and treatment year were significant for LC. Acute >= grade 3 toxicity occurred in 24% of patients. Actuarial late >= grade 3 toxicity was 23% at 3-years. In multivariable analysis reRT fraction dose was significantly related to late >= grade 3 toxicity.Conclusion: reRT + HT is an effective curative and palliative treatment option for patients with irresectable locoregional recurrent breast cancer in previously irradiated area. Early referral, treatment of chest wall recurrences <= 5 cm in the absence of distant metastases, provided the highest local control rates. The cumulative effects of past and present treatments should be accounted for by adjusting treatment protocol to minimize toxicity. (C) 2015 Elsevier Ireland Ltd. All rights reserved. Show less
