Radiotherapy for locally recurrent breast cancer
Yeh, C.Y.; Chung, C.H.; Liu, M.T.
Journal of the Formosan Medical Association 89(7): 554-558
1990
ISSN/ISBN: 0929-6646 PMID: 1979597 Document Number: 348826
A total of 43 breast cancer patients were treated at the Department of Radiation Oncology, Mackay Memorial Hospital from January 1978 to December 1987 for postoperative local-regional recurrence. Twenty-six patients developed local recurrence within 12 months after surgery and 17 patients developed local recurrence after 12 months. The mean age for this group of patients was 52 years (range: 27-82). There were 26 postmenopausal and 17 premenopausal patients. Twenty-four patients had received chemotherapy with cyclophosphamide, methotrexate and 5-fluorouracil (CMF) regimen. Four patients were excluded from this study due to incompletion of radiotherapy. Sites of local recurrence in the remaining 39 patients included: chest wall, single (8) and multiple (4); axilla (7); supraclavicular area (5); chest wall with regional node (11); and multiple regional nodes (4). All were free of distant metastasis at the initiation of radiotherapy. A mean tumor dose of 5000 cGy in 28 fractions was given over a 6-week period to the chest wall and draining lymphatics, using an AECL Theratron 80 or a CGR Alcyon MEV Cobalt-60 unit. The overall local control rate was 72%, and the 5-year local control rate was 59%. Nine patients experienced a second local recurrence, with a median interval of 8 months after radiotherapy. Four of them (4/9) also showed evidence of systemic disease at the same time. Distant metastasis, the major cause of mortality, appeared in 49% of the patients with a median interval of 22.8 months after radiotherapy. The three leading sites of distant metastasis were the bones (42%), lungs (37%) and liver (16%). Our study showed that the significant factors affecting the local control rate included the initial histologic status of the axillary nodes, the site of initial recurrence and the type of previous mastectomy. Factors affecting the survival rate included the number of recurrent tumors and the duration of the disease-free interval. The overall survival rate at 5 years was 41% and the disease-free survival rate was 33%. This study showed that the highest survival rate is achieved with radiotherapy in patients recurring with only a single chest wall tumor, as compared with those having nodal or multiple recurrent tumors (5-year survival: 38% vs 16%, respectively).