{Reference Type}: Journal Article
{Title}: Hypofractionated partial breast re-irradiation in the conservative retreatment of breast cancer local recurrence.
{Author}: Leonardi MC;Arculeo S;Frassoni S;Zerella MA;Gerardi MA;Fodor C;Veronesi P;Galimberti VE;Magnoni F;Milovanova E;Rojas DP;Dicuonzo S;Morra A;Zaffaroni M;Vincini MG;Cattani F;Bagnardi V;Orecchia R;Jereczek-Fossa BA;
{Journal}: Pract Radiat Oncol
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jul 26
{Factor}: 3.439
{DOI}: 10.1016/j.prro.2024.07.003
{Abstract}: OBJECTIVE: to evaluate the outcome of partial breast re-irradiation (re-PBI) with intensity modulated RT (IMRT), using a hypofractionated scheme for breast cancer (BC) local recurrence (LR) operated on with repeat breast-conserving surgery (re-BCS).
METHODS: IMRT-based re-PBI was performed using either helical or step-and-shoot modality to deliver 37.05 Gy in 13 fractions in 2.5 weeks. Cumulative incidence (CumI) of 2ndLR, toxicity, disease-free (DFS), BC specific (BCSS), and overall (OS) survival were evaluated.
RESULTS: Between 5/2012 and 5/2021, 70 patients had re-PBI. Median follow-up (FU) was 6.3 years (Q1-Q3, 4.0-8.1.). Median age at 1stLR was 62. The median primary BC-1stLR interval was 12.4 years (range: 1.6-26.7). Luminal A-like 1stLR accounted for 41% of the cases and median size was 0.8 cm. During FU, 18 (26%) patients showed a subsequent event: three 2snLRs (corresponding to 8-y Cumulative rate of 4%), 3 regional nodal recurrences, 7 distant metastases, and 5 other primary tumors. At 8 years, DFS, BCSS and OS were 76%, 90%, and 90%, respectively. At multivariate analysis, Grade 3 and extensive intraductal component were independent predictors for DFS. For 51 and 46 patients, chronic toxicity and cosmesis were evaluated, respectively: 4% had grade 3 fibrosis and cosmesis was deemed good/excellent in just over 60% of the cases.
CONCLUSIONS: Re-PBI after re-BCS represents a feasible alternative to mastectomy with regard to local control, showing an acceptable toxicity profile. A long-term FU is crucial to better understand the pattern of relapse and consolidate the position of re-PBI in clinical practice.