Local-regional treatment of patients with simultaneous local-regional recurrence and distant metastases following mastectomy

Publisher Website
Google Scholar
Abstract
HIGH-DOSE, LARGE VOLUME LOCAL-REGIONAL irradiation has been shown to be necessary in patients with local-regional recurrence of breast cancer without coexisting distant metastases; however, no studies exist that deal with the dose and volume of local-regional irradiation required for patients with both local-regional recurrence and distant metastases. This report is an analysis of 68 patients who presented with previously untreated local-regional recurrence and coexisting distant metastases. Thirty-five of these patients were treated with local-regional irradiation and systemic therapy; the remaining 33 patients received systemic therapy only. An analysis of the dose and volume in the 35 irradiated patients showed that if the irradiation was inadequate (dose <4500 rad and volume not large enough to encompass the entire involved site), the incidence of uncontrolled local-regional disease for the duration of life was 79%, similar to the 64% rate of uncontrolled local-regional disease in the 33 patients not receiving local-regional irradiation. On the other hand, if the dose to the recurrence was at least 4500 rad and if the field was large enough to encompass the entire site containing the recurrence, the incidence of uncontrolled local-regional disease for the duration of life was only 27%. The present study also suggests that local-regional irradiation may be indicated in patients with asymptomatic as well as symptomatic local-regional disease. In patients with distant metastases and initially asymptomatic local-regional disease, adequate irradiation resulted in a lower incidence of ultimate local-regional symptoms when compared to similar patients who were treated with inadequate or no local-regional irradiation. This difference was not quite statistically significant because of the small number of patients in each group. Summary There are no data currently available to indicate the optimum irradiation dose and volume for the treatment of the local-regional disease in patients who have coexisting local-regional and distant recurrence. The present study suggests that the total dose should be at least 4500 rad and the volume should be large enough to encompass the entire site containing the recurrence. Irradiation to the local-regional recurrence is clearly indicated in those patients with symptomatic local-regional disease. In addition, the present study suggests that adequate local-regional irradiation may prevent the ultimate development of local-regional symptoms in patients whose local-regional disease is initially asymptomatic.

This publication has 2 references indexed in Scilit: