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

CHICAGO--Although mastectomyis the preferred method of treatmentfor most patients with local recurrenceof breast cancer in the preservedbreast, repeat breast-conserving surgeryfollowed by partial-breast radiotherapyis "generating a lot of excitement," SeemaA. Khan, MD, said at the 8th AnnualLynn Sage Breast Cancer Symposium.

Published experience is limited. However,there are indications that partialbreastradiotherapy may be useful forwomen with a localized recurrence despiteprior breast irradiation, said Dr.Khan, professor of surgery and medicaldirector of the Bluhm Family Breast CancerEarly Detection and Prevention Program,Robert H. Lurie ComprehensiveCancer Center, Northwestern UniversityFeinberg School of Medicine.

Repeat partial-breast radiotherapymay be feasible for women who have anew primary cancer in the breast afterreceiving a previous course of partialbreastradiotherapy for a different primarybreast tumor. It may also be givento patients who develop a new primarytumor after whole-breast radiotherapy.In such patients, partial-breast radiotherapymay be delivered to a tumor areaother than the one that had been targetedas the site of the radiation boost.For both groups of patients, partial-breastradiotherapy has been proposed as amethod that would allow surgeons toachieve an acceptable level of local controlof disease by means of repeat breastconservingsurgery, she said.

Three Studies
A review of 39 women, median follow-up 5 years, who had brachytherapyto the breast between 1990 and 1997 assessedoutcomes after perioperative irradiationinvolving a total of 30 Gy andsplit-course brachytherapy ranging from60 to 70 Gy. Eight patients (21%) had alocal recurrence of breast cancer andseven (185) developed metastatic disease.Three patients required mastectomy becauseof complications from radiotherapy,Dr. Khan said.

A study by Melvin Deutsch, MD, of39 women who had in-breast recurrenceof cancer evaluated the effects of repeatexternal beam radiotherapy delivered tothe site of recurrence. At a median follow-up of 5 years, eight patients (27%)had a local recurrence, and eight had distantspread of disease. Four patients hadboth local recurrence and distant disease.

Among 57 women from the EuropeanInstitute of Oncology, Milan, Italy whowere selected for repeat breast-conservingsurgery on the basis of a recurrenttumor less than 1 cm in size, the recurrencerate after a follow-up of 71 monthswas 19%. Dr. Khan said that investigatorsin Milan are now evaluating thefeasibility and effiacy of intraoperativepartial breast radiotherapy in women undergoingrepeat breast-conserving surgeryfor in-breast cancer recurrence.

Limited, early data from the studysuggest that repeat partial breast radiotherapyis safe, Dr. Khan said, but longtermsafety of repeat radiotherapy hasyet to be determined. Dr. Khan concludedthat, while repeat radiotherapy may beconsidered for patients with in-breast recurrenceof cancer, its efficacy must bedemonstrated in larger trials.