Radiotherapy for and prognosis of breast cancer patients with isolated chest wall recurrence after mastectomy / 中华放射肿瘤学杂志

Objective:To investigate the radiation field and dose selection of patients with isolated chest wall recurrence (ICWR) after modified radical mastectomy, and analyze the prognostic factors related to subsequent chest wall recurrence.Methods:Clinical data of 201 patients with ICWR after mastectomy admitted to the Fifth Medical Center, Chinese PLA General Hospital from 1998 to 2018 were retrospectively analyzed. None of the patients received postoperative adjuvant radiotherapy. After ICWR, 48 patients (73.6%) underwent surgery and 155 patients (77.1%) received radiotherapy. Kaplan-Meier method was used to calculate the post-recurrence progression-free survival (PFS) rates and the difference was compared by log-rank test. Multivariate analysis was performed using Cox regression model. Competing risk model was adopted to estimate the subsequent local recurrence (sLR) rates after ICWR and the difference was compared with Gray test. Multivariate analysis was conducted using F&G analysis. Results:With a median follow up of 92.8 months after ICWR, the 5-year PFS rate was 23.2%, and the 5-year sLR rate was 35.7%. Multivariate analysis showed that patients with surgery plus radiotherapy and recurrence interval o F>12 months had a lower sLR rate. Patients with recurrence interval o F>48 months, local plus systemic treatment and surgery plus radiotherapy had a higher PFS rate. Among the 155 patients who received chest wall radiotherapy after ICWR, total chest wall irradiation plus local boost could improve the 5-year PFS rate compared with total chest wall irradiation alone (34.0% vs. 15.4%, P=0.004). Chest wall radiation dose (≤60 Gy vs.>60 Gy) exerted no significant effect upon the sLR and PFS rates (both P>0.05). In the 53 patients without surgery, the 5-year PFS rates were 9.1% and 20.5%( P=0.061) with tumor bed dose ≤60 Gy and>60 Gy, respectively. Conclusions:Local radiotherapy is recommended for patients with ICWR after modified radical mastectomy of breast cancer, including total chest wall radiation plus local boost. The radiation dose for recurrence should be increased to 60 Gy, and it should be above 60 Gy for those who have not undergone surgical resection. In addition, patients with ICWR still have a high risk of sLR, and more effective treatments need to be explored.

Experience of Photodynamic Therapy for Palliation of the Chest Wall and Skin Recurrence in a Patient with Breast Cancer

In patient treated by mastectomy for breast cancer, chest wall and skin recurrences are frequently encountered. Chest wall recurrence results in profound physical and psychological morbidity, and often heralds the appearance of other, more life threatening metastasis. Traditionally the two most common treatments have been site-specific radiation and resection. Photodynamic therapy (PDT) provided an alternative treatment modality using a photosensitizer and laser light to induce selective tumor necrosis. The patient was 64- years old female, had undergone breast conserving surgery for cancer of the right breast. Chest wall and skin metastasis recurred at 40 months after the adjuvant treatment of chemotherapy. The lesions were progressed despite 2nd, 3rd chemotherapy and hyperthermal therapy. The light was administered through a diode laser turned to 630 nm wave length (150 J/cm2 in light dosage, 200 mW/cm2 in intensity), 72 h after photosensitizing agent injection. There was clinical evidence of partial response, defined as granulation tissue with re-epitheliaization from the periphery of normal epithelium. PDT has demonstrated good results in other solid tumors at some hospitals, however there has been no application for breast cancer in Korea previously. Our experience suggests that PDT is non-invasive procedure that is highly tolerable, particularly when compared with other modalities, and an effective treatment method for chest wall or skin recurrence that shows no response to other treatments.

The clinical analysis of chest wall recurrence of breast cancer after mastectomy / 中国癌症杂志

Background and Purpose:The recurrent rate of breast cancer after mastectomy was 5%~20%,high risk factors were included it could achieve 34%~40%,Chest wall recurrence was the most common.This paper explores the reason for chest wall recurrence of breast cancer after mastectomy,hoping to find an efficient way to prevent and reduce chest wall recurrence after mastectomy.Methods:For 39 patients with local recurrence on the chest wall after mastectomy clinical data was reviewed retrospectively.Results:This group of patients was 5.1% of all breast cancer patients in the same period.Most of recurrences(59.0%)occured within two years affer operation.The recurrent rate of T_1～T_4 was 1.6%、1.9%、9.7% and 37.2% respectively.Rate of chest wall recurrence in patients with negative axillary nodes and positive axillary nodes was 1.3%、7.6%,but if the amount of positive axillary nodes≥4,it was 13.4%.Conclusions:In the patients who had more positive axillary nodes,larger primary tumor and no proper adjuvant therapy,recurrence on the chest wall was seen more often.Adjuvant chemotherapy and postoperative radiotherapy are efficient ways to prevent recurrence on the chest wall.