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.
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.