Thermoradiotherapy for locally recurrent breast cancer with skin involvement

Purpose: This retrospective analysis investigated the effectiveness and sid e-effects of combined hyperthermia and radiation therapy in locally recurre nt breast cancer after primary modified radical mastectomy. The aim of the thermoradiotherapy was to reduce the substantial risk of symptomatic chest wall disease. Materials and methods: Between May 1995-August 1998, 39 extensively pre-tre ated women with progressive locoregional chest wall tumours were treated wi th local radiofrequency hyperthermia, given twice a week immediately before radiotherapy. Sixty-two per cent of the patients had received previous rad iotherapy, with a median dose of 50 Gy, 64% had received chemotherapy, 36% hormonal therapy, and 13% local therapy with miltefosin, respectively. Nine patients were treated for microscopic residual disease after local tumour excision (R1-resection) and 30 patients for gross macroscopic nodular recur rences. Twenty-seven patients had two adjacent hyperthermia fields at the i psilateral chest wall to cover the whole irradiation area. Each field recei ved a median of seven local hyperthermia sessions (range 2-12, average 5.6 sessions) just before radiation therapy, with a median dose of 60 Gy (range 30-68 Gy). The monitored maximum(average) and average(average) epicutaneou s temperatures were 42.1 degreesC and 41.0 degreesC, respectively. Maximum( average) and average(average) intratumoural temperatures of 43.0 degreesC a nd 41.1 degreesC, respectively, were achieved in nine chest wall recurrence s with intratumoural temperature probes. Concurrent hormonal therapy was ad ministered in 48%, and concurrent chemotherapy in 10% of patients. Results: Median overall survival time was 28 months (Kaplan Meier), with 71 % and 54% of patients living 1 and 2 years after thermoradiotherapy. The me dian time to local failure has not been reached, local tumour control after 2 years being 53%. Actuarial 1 and 2 year local tumour controls for micros copic residual disease were 89%, and for macroscopic nodular recurrences 71 % and 46%, respectively (p = 0.09). Actuarial 1 and 2 year local tumour con trols after treatment with a total dose of less than 60 Gy were 51% and 38% , respectively, and, after a total dose greater than 60 Gy, 84% and 60% (p = 0.01), respectively. Actuarial 1 year local tumour control was 92% after complete tumour remission, versus 57% after partial remission (p = 0.002). Three of the 39 patients died of cancer en cuirasse, 13 patients due to dis tant metastases. Acute thermoradiotherapy related erythema, dry desquamatio n and moist desquamation were seen in 28.2%, 30.7%, and 30.7% of patients, respectively. Soft tissue necrosis occurred in two patients with previous p ost-operative delayed wound healing, and in one patient above a silicon imp lant. Conclusion: This study showed that, in extensively pre-treated patients wit h locally recurrent breast cancer, local tumour control after thermoradioth erapy depended on tumour resectability, response of macroscopic tumour to t hermoradiotherapy, and total irradiation dose.