Second breast-conserving therapy with interstitial brachytherapy (APBI) as a salvage treatment in ipsilateral breast tumor recurrence: a retrospective study of 40 patients

• Published in: Journal of contemporary brachytherapy Vol. 11; no. 2; pp. 101 - 107
• Main Authors: Cozzi, Salvatore, Jamal, Dina Najjari, Slocker, Andrea, Laplana, Maria, Tejedor, Amparo Garcia, Krengli, Marco, Guedea, Ferran, Gutierrez, Cristina
• Format: Journal Article
• Language: English
• Published: Poland Termedia Publishing House 01.04.2019
• Subjects: apbi; brachytherapy; Breast; Breast cancer; Cancer; Disease control; Fibrosis; local relapse; Mastectomy; Original Paper; Patients; Radiation therapy; Salvage; salvage brachytherapy; Survival; Toxicity; Tubes; Tumors; APBI; salvage brachytherapy; breast cancer; local relapse; brachytherapy
• ISSN: 1689-832X; 2081-2841
• DOI: 10.5114/jcb.2019.84689

Breast-conserving treatment (BCT) have emerged as an alternative to mastectomy in patients with ipsilateral breast tumor recurrence (IBTR). We evaluated survival outcomes and treatment-related toxicity in a series of 40 patients with IBTR, who underwent tumorectomy plus interstitial brachytherapy (APBI) as a salvage treatment. Retrospective analysis included 40 patients diagnosed with IBTR and treated with intraoperative (26 patients) or post-operative (14 patients) multicatheter brachytherapy for APBI at our institution between June 2002 and October 2017. We assessed cosmesis, toxicity, overall survival (OS), and cancer-specific survival (CSS). Tumorectomy was performed in all cases, including intraoperative tumor margin assessment and sentinel node biopsy. Median age was 65 years (range, 41-92). The total prescribed dose was 32 Gy (8 fractions) in 19 patients and 34 Gy (10 fractions) in 20 patients. One elderly patient (age 92) received a single fraction of 16 Gy. Median follow-up was 61.5 months (range, 6-153). A median of 14 tubes were inserted. Mean treated V was 115 cc. Two patients developed a second relapse at 3 and 5 years after salvage treatment: one patient underwent salvage mastectomy and remains alive 10 years after brachytherapy, and the second one developed both local relapse and bone metastasis. The disease is stable at present. Five-year OS and CSS rates were 85.3% and 97.5%, respectively. Two patients died from cancer-related causes. Acute and late toxicity rates were low; seven patients developed acute infectious mastitis. Late fibrosis > grade 3 and late mastitis were observed in 14 and 6 cases, respectively. Second BCT with APBI as a salvage treatment in ipsilateral breast recurrence achieves good local disease control, with a satisfactory toxicity profile compared to mastectomy. This approach seems to be safe and effective, although more data from randomized trials are needed.