Best radiation therapy when breast cancer comes back?

The research discussed in this summary was published on Research Square as a preprint and has not yet been peer-reviewed.

Key Takeaway

  • Among patients with recurrent or new-onset breast cancer, a second breast-conserving operation followed by reirradiation was safe and effective in a variety of radiation treatments.

Why this matters

  • Salvage mastectomy has been the standard of care when breast cancer survivors have recurrent or new primary tumors.

  • Lumpectomy and reirradiation have emerged as viable options, but data on the safety and efficacy of different radiation fractionation options are still limited.

  • The current study suggests that once-daily, dosed dosing is a safe and effective alternative to conventional twice-daily radiation.

Design studies

  • The researchers reviewed the outcomes of 66 breast cancer survivors who underwent mastectomy and re-radiation for recurrent or new primary tumors.

  • At recurrence, 41% had invasive carcinoma with a ductal carcinoma in situ (DCIS) component, 41% had invasive carcinoma alone, and 18% had DCIS alone.

  • Most of the women had hormone receptor-positive and HER2-negative early-stage disease, and all were node-negative.

  • Postoperatively, 95% received partial breast irradiation, of which 57.5% with 45 Gy given in 1.5 Gy fractions twice daily; 27% with 45 Gy in 1.8 Gy fractions once daily; and 10.5% with a low fraction in the range of 2.6-8 Gy per fraction.

  • The remaining women received approximately 45 Gy of whole-breast radiation in 1.8-2 Gy fractions.

Main results

  • At 2 years, overall survival and site recurrence-free survival were both 100%; distant metastasis-free survival was 91.6%.

  • Only two patients developed a late, grade 3 radiation event: remote control at 1 year and fibrosis at 3 years; no stages 4 or 5 occurred.

  • Choice of fractional treatment and cumulative dose were not associated with acute or late toxicity.

Limitations

  • This was a retrospective study with limited follow-up and a small study population.

  • Only a few patients received hypofractionated and hyperfractionated radiation.

  • There were differences in the reporting of adverse events between the two participant populations.

Disclosures

This is a summary of a preprint study, “Efficacy and toxicity of reirradiation after breast-conserving surgery for recurrent or new primary breast cancer: a multicenter study,” led by Camille Hardy Abeloos of NYU Langone Medical Center, New York. York City, brought to you by Medscape. The study has not been peer-reviewed. The full text can be accessed at researchsquare.com.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and journalism from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com.

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