The feasibility of a second lumpectomy and breast brachytherapy for localized cancer in a breast previously treated with lumpectomy and radiation therapy for breast cancer

Manjeet Chadha, Sheldon Feldman, Susan Boolbol, Lin Wang, Louis B. Harrison

Research output: Contribution to journalArticle

54 Scopus citations

Abstract

Purpose: With accumulating evidence supporting partial-breast irradiation, we conducted a Phase I/II study to evaluate the role of a second conservative surgery and brachytherapy for patients presenting with a local recurrence/new primary in a breast who has previously undergone a lumpectomy and external radiation therapy for breast cancer. Methods and materials: Fifteen patients with a localized lesion in the breast have undergone a second lumpectomy and received low-dose-rate brachytherapy on protocol. The first 6 patients received a dose of 30 Gy. With no unacceptable acute toxicity observed, the brachytherapy dose was increased to 45 Gy. Three patients received adjuvant chemotherapy and 8 patients are on antiestrogen therapy. Results: The median time interval between the primary breast cancer diagnosis and the second cancer event in the ipsilateral breast is 94 months (range, 28-211). With a median followup of 36 months after brachytherapy, the 3-year Kaplan-Meier overall survival, local disease-free survival and mastectomy-free survival are 100% and 89%, respectively. There was no Grade 3/4 fibrosis or necrosis observed. All patients had baseline asymmetry due to the breast volume deficit from the second lumpectomy. With breast asymmetry as a given, the cosmetic result observed in all patients has been good to excellent. Conclusions: Early results suggest low-complication rates, high rate of local control and freedom from mastectomy. Additional studies are needed to establish whether a second lumpectomy and breast brachytherapy are an acceptable alternative to mastectomy for patients presenting with a localized cancer in a previously irradiated breast.

Original languageEnglish (US)
Pages (from-to)22-28
Number of pages7
JournalBrachytherapy
Volume7
Issue number1
DOIs
StatePublished - Jan 1 2008
Externally publishedYes

Keywords

  • Accelerated irradiation
  • Breast-conserving therapy
  • Partial-breast brachytherapy
  • Recurrent breast cancer
  • Second lumpectomy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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