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The Role of Partial Breast Radiation in the Previously Radiated Breast

Korzets, Yasmin MD*,†,‡; Lee, Grace MD; Espin-Garcia, Osvaldo MD§; Purdie, Thomas MD*,†; Koch, Anne C. MD*,†; Hodgson, David MD*,†; Barry, Aisling MD*,†; Fyles, Anthony MD, FRCPC*,†

American Journal of Clinical Oncology: December 2019 - Volume 42 - Issue 12 - p 932–936
doi: 10.1097/COC.0000000000000584
Original Articles: Breast
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Objectives: The aim of this study was to analyze breast cancer patients who previously had mantle-field or breast radiation (RT) followed by retreatment with external beam partial breast irradiation (EB PBI).

Materials and Methods: We retrospectively reviewed all women with newly diagnosed early-stage breast cancer treated with lumpectomy and partial breast irradiation between 2007 and 2017 who had undergone prior chest or breast RT.

Results: Of 11 patients recorded, 8 (73%) had Hodgkin lymphoma, and 3 (27%) had ipsilateral breast cancer diagnosis. Median age at initial and second diagnosis was 28 and 48 years, respectively. The lymphoma patients received a dose of 35 Gy in 16 to 20 fractions to a classic mantle-upper abdomen field. Patients with an initial diagnosis of breast cancer received whole-breast RT (2 with 50 Gy/25 fractions, 1 with 40 Gy in 16 fractions). Median time from initial to second diagnosis was 22.6 years (range, 13.5 to 32.6 y). All had early-stage (I to II) invasive ductal carcinoma and were treated with lumpectomy or repeat lumpectomy and EB PBI. Four received a dose of 45 Gy/25 fractions, 4 to 50 Gy/25 fractions, and 3 to 42.4 Gy/16 fractions. All patients received adjuvant systemic treatment. Two patients had toxicity, 1 had grade 1 induration, and the other had grade 2 fat atrophy and grade 1 fibrosis. One patient developed a contralateral breast cancer. No locoregional recurrences were reported at the median follow-up of 4.6 years (range, 0.6 to 10.5 y).

Conclusion: EB PBI after lumpectomy seems to be a safe and effective RT treatment option for selected patients with prior RT and localized early-stage breast cancer.

*Department of Radiation Oncology, University of Toronto

Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto

§Department of Biostatistics, Princess Margaret Cancer Centre/Ontario Cancer Institute, ON, Canada

Davidoff Cancer Center, Beilinson Hospital–Rabin Medical Center, Petach Tikva affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

The authors declare no conflicts of interest.

Reprints: Anthony Fyles, MD, FRCPC, Department of Radiation Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, Canada M5G 2M9. E-mail: anthony.fyles@rmp.uhn.ca.

Online date: August 20, 2019

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