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Lumpectomy With Repeat RT Should Be Investigated as an Option for Patients With In-Breast Cancer Recurrence

Lumpectomy With Repeat RT Should Be Investigated as an Option for Patients With In-Breast Cancer Recurrence

CHICAGO--Although mastectomy is the preferred method of treatment for most patients with local recurrence of breast cancer in the preserved breast, repeat breast-conserving surgery followed by partial-breast radiotherapy is "generating a lot of excitement," Seema A. Khan, MD, said at the 8th Annual Lynn Sage Breast Cancer Symposium.

Published experience is limited. However, there are indications that partialbreast radiotherapy may be useful for women with a localized recurrence despite prior breast irradiation, said Dr. Khan, professor of surgery and medical director of the Bluhm Family Breast Cancer Early Detection and Prevention Program, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine.

Repeat partial-breast radiotherapy may be feasible for women who have a new primary cancer in the breast after receiving a previous course of partialbreast radiotherapy for a different primary breast tumor. It may also be given to patients who develop a new primary tumor after whole-breast radiotherapy. In such patients, partial-breast radiotherapy may be delivered to a tumor area other than the one that had been targeted as the site of the radiation boost. For both groups of patients, partial-breast radiotherapy has been proposed as a method that would allow surgeons to achieve an acceptable level of local control of disease by means of repeat breastconserving surgery, she said.

Three Studies
A review of 39 women, median follow- up 5 years, who had brachytherapy to the breast between 1990 and 1997 assessed outcomes after perioperative irradiation involving a total of 30 Gy and split-course brachytherapy ranging from 60 to 70 Gy. Eight patients (21%) had a local recurrence of breast cancer and seven (185) developed metastatic disease. Three patients required mastectomy because of complications from radiotherapy, Dr. Khan said.

A study by Melvin Deutsch, MD, of 39 women who had in-breast recurrence of cancer evaluated the effects of repeat external beam radiotherapy delivered to the site of recurrence. At a median follow- up of 5 years, eight patients (27%) had a local recurrence, and eight had distant spread of disease. Four patients had both local recurrence and distant disease.

Among 57 women from the European Institute of Oncology, Milan, Italy who were selected for repeat breast-conserving surgery on the basis of a recurrent tumor less than 1 cm in size, the recurrence rate after a follow-up of 71 months was 19%. Dr. Khan said that investigators in Milan are now evaluating the feasibility and effiacy of intraoperative partial breast radiotherapy in women undergoing repeat breast-conserving surgery for in-breast cancer recurrence.

Limited, early data from the study suggest that repeat partial breast radiotherapy is safe, Dr. Khan said, but longterm safety of repeat radiotherapy has yet to be determined. Dr. Khan concluded that, while repeat radiotherapy may be considered for patients with in-breast recurrence of cancer, its efficacy must be demonstrated in larger trials.

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