[Simultaneous radiochemotherapy in locoregional recurrent breast carcinoma after mastectomy. Results in patients with macroscopic residual tumor R2].

PURPOSE

The aim of this study was to create a treatment policy for macroscopic persistent tumor (R2) in the case of locoregional recurrent breast cancer after mastectomy. The large amount of persisting tumor cells before radiation therapy requires an aggressive therapeutic regime as known by literature. In this tumor situation our therapeutic concept is the combined simultaneous radiation and chemotherapy.

PATIENTS AND METHODS

A retrospective evaluation of treatment and follow-up data of 71 patients was made. The median follow-up was 26.4 months. The local radiation therapy was combined with simultaneous chemotherapy, radiotherapy was triggered by the rhythm of chemotherapy: chemotherapy was given by CMF regime with modification according to dosage. Duration of chemotherapy was 2 weeks followed by 2 weeks without any therapy. Four courses of this regime were given. Irradiation was done simultaneously to chemotherapy using a split course technique. All patients had a visible and palpable macroscopic residual tumor before starting therapy so that the result of therapy could be documented easily.

RESULTS

At the end of the therapy the complete remission rate (CR) was 89%. This was not depending on radiation dose if more than 30.00 Gy were given. For patients with CR the 5-year-probability of a re-recurrence infield is 29%. The rate of re-recurrence was depending on radiation dose. Increasing the dosage by boost technique above 50.00 Gy decreased re-recurrence to 50% of the value found by dosage of less than 50.00 Gy. Due to ipsilateral re-recurrence outfield the 5-year-probability for ipsilateral local tumor to be controlled continuously is 45%. The median overall survival rate of all patients was 32.5 months. Patients without haematogenous metastases at the beginning of the therapy and continuous local tumor control reached a median survival rate of 42.6 months in contrast to patients with haematogenous metastases or no local tumor control which had a median survival rate of 26.3 months (p < 0.04).

CONCLUSION

The combined simultaneous radio-chemotherapy in the case of locoregionally recurrent breast cancer with macroscopic residual tumor (R2) is a successful treatment concept. A prospective study was initiated by ARO study group of the German Cancer Society to improve these data.