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Results of irradiation in the treatment of local-regional breast cancer recurrence
Proceedings of the 1st Annual ASTRO Meeting
141
124 RESULTS OF IRRADIATION IN THE TREATMENT OF LOCAL-REGIONAL BREAST CANCER RECURRENCE Karl Kong-yuan Chen, M.D. and Eleanor D. Montague University of Texas M. D. Anderson Hospital and Tumor Institute at Houston A retrospective review is presented of 221 patients with chest wall and/or regional (nodal) recurrent breast cancer treated between 1955-1980 at the UT M. D. Anderson Hospital. A radical or modified radical mastectomy was the initial treatment for 183 patients and simple mastectomy was done in 38 patients. With generous fields including the chest wall and regional node areas and supervoltage doses ranging from 45007000 rad (200 rad/day), irradiation failed to control 20% of sites (independent for prior surgical excision or systemic treatment). The 5 and 10 year overall survival is 4490 and 22% and disease-free survival is 28% and 18% respectively. The 5 year disease-free survival with a single recurrent site is the same (31-33%) for patients with a chest wall, axilla and internal mammary recurrence, and is reduced (15%) for patients with supraclavicular or multiple recurrent sites. The only other factor affecting survival is the initial axillary histology; of patients with local-regional recurrence with initially negative axillary nodes, the diseasefree survival is 36%, with 1-3 positive nodes-34% and with 4 or more positive nodes-4%. Nineteen patients receiving systemic treatment as adjuvant to irradiation showed no survival benefit. Other possible prognostic factors such as disease-free interval, previous radiotherapy, number and sites of recurrence, size of recurrent tumors and location of chest wall recurrence relative to the mastectomy scar will be analyzed.
125 STAGE I AND II BREAST CANCER TREATED Carl M. Mansfield,
M.D., William
BY INTRAOFERATIVE
R. Jewell,
M.D.,
INTERSTITIAL
Leela Krishnan,
IMFLANTATION. M.D., Gordon
Departments of Radiation Therapy and Surgery, Thomas Jefferson University Radiation Therapy and Surgery, University of Kansas Medical Center.
F. Schwartz,
Hospital,
M.D.
and departments
of
Since mid 1982, whenever possible, we have performed an Iridium-192 interstitial implant at the time of Immediately a ter removal of the tumor with its surrounding normal tissue, the surgeon indilumpectomy. 'the tumor bed and they agree upon the volume to be implanted. The'implant is cates to the radiotherapis e then performed, under direct visualization, while the surgical wound is still opened. This approach has not been used routinely in the conservative treatment of breast cancer. However, on the basis of our experience, it is a procedure that has the advantage of: 1) increasing the accuracy of the implantation thereby possibly further decreasing the local recurrence; 2) eliminating the need for a second anesthesia for a subsequent implantation; and 3) the overall treatment time from lumpectomy to completion of radiation therapy is shortened. The acute and chronic comolications and cosmetic results To date, there have been no local recurrences. be presented.
in 84 patients
followed
for 3 to 27 monthswill
126 RADIATION THERAPY Jerry
FOR UNRESECTABLE
D. Slater,M.D., Marsha D. McNeese,
The University 77030
of Texas
System
Cancer
SOFT TISSUE SARCOMAS
M.D., and Lester J. Peters,M.D.
Center,
M.D. Anderson
Hospital
and Tumor Institute
at Houston,
Houston,
Texas
Between 1954 and 1981, 72 patients with unresectable soft tissue sarcomas were treated with radiotherapy alone, at the U.T. M. D. Anderson Hospital (MDAH), 57 patients with photons alone and 15 patients receiving at least part of the treatment with neutrons using the Texas A&M Variable Energy Cyclotron. There were no significant differences in local control according to tumor size or location, number of previous excisions, but tumor grade was an important prognostic factor. Patients receiving doses of 6100 rad or greater did no better than those receiving 4000 to 6000 rad. The proportion disease-free at 5 years for 12 patients with grade 1 tumors was 58% compared to 32% and 17% for 10 patients with grade 2 and 50 patients with grade 3 respectively. Of the 57 patients treated with photons alone, the proportion disease-free at 5 years was 28%, compared with 80% for patients in whom gross removal of the tumor could be accomplished. Of the 15 patients treated with neutrons, 40% were disease-free at 5 years. Although this improvement in local control with neutrons is not statistically significant because of the size of the groups, further investigation of neutron therapy for nonresectable tumors is indicated.
141
124 RESULTS OF IRRADIATION IN THE TREATMENT OF LOCAL-REGIONAL BREAST CANCER RECURRENCE Karl Kong-yuan Chen, M.D. and Eleanor D. Montague University of Texas M. D. Anderson Hospital and Tumor Institute at Houston A retrospective review is presented of 221 patients with chest wall and/or regional (nodal) recurrent breast cancer treated between 1955-1980 at the UT M. D. Anderson Hospital. A radical or modified radical mastectomy was the initial treatment for 183 patients and simple mastectomy was done in 38 patients. With generous fields including the chest wall and regional node areas and supervoltage doses ranging from 45007000 rad (200 rad/day), irradiation failed to control 20% of sites (independent for prior surgical excision or systemic treatment). The 5 and 10 year overall survival is 4490 and 22% and disease-free survival is 28% and 18% respectively. The 5 year disease-free survival with a single recurrent site is the same (31-33%) for patients with a chest wall, axilla and internal mammary recurrence, and is reduced (15%) for patients with supraclavicular or multiple recurrent sites. The only other factor affecting survival is the initial axillary histology; of patients with local-regional recurrence with initially negative axillary nodes, the diseasefree survival is 36%, with 1-3 positive nodes-34% and with 4 or more positive nodes-4%. Nineteen patients receiving systemic treatment as adjuvant to irradiation showed no survival benefit. Other possible prognostic factors such as disease-free interval, previous radiotherapy, number and sites of recurrence, size of recurrent tumors and location of chest wall recurrence relative to the mastectomy scar will be analyzed.
125 STAGE I AND II BREAST CANCER TREATED Carl M. Mansfield,
M.D., William
BY INTRAOFERATIVE
R. Jewell,
M.D.,
INTERSTITIAL
Leela Krishnan,
IMFLANTATION. M.D., Gordon
Departments of Radiation Therapy and Surgery, Thomas Jefferson University Radiation Therapy and Surgery, University of Kansas Medical Center.
F. Schwartz,
Hospital,
M.D.
and departments
of
Since mid 1982, whenever possible, we have performed an Iridium-192 interstitial implant at the time of Immediately a ter removal of the tumor with its surrounding normal tissue, the surgeon indilumpectomy. 'the tumor bed and they agree upon the volume to be implanted. The'implant is cates to the radiotherapis e then performed, under direct visualization, while the surgical wound is still opened. This approach has not been used routinely in the conservative treatment of breast cancer. However, on the basis of our experience, it is a procedure that has the advantage of: 1) increasing the accuracy of the implantation thereby possibly further decreasing the local recurrence; 2) eliminating the need for a second anesthesia for a subsequent implantation; and 3) the overall treatment time from lumpectomy to completion of radiation therapy is shortened. The acute and chronic comolications and cosmetic results To date, there have been no local recurrences. be presented.
in 84 patients
followed
for 3 to 27 monthswill
126 RADIATION THERAPY Jerry
FOR UNRESECTABLE
D. Slater,M.D., Marsha D. McNeese,
The University 77030
of Texas
System
Cancer
SOFT TISSUE SARCOMAS
M.D., and Lester J. Peters,M.D.
Center,
M.D. Anderson
Hospital
and Tumor Institute
at Houston,
Houston,
Texas
Between 1954 and 1981, 72 patients with unresectable soft tissue sarcomas were treated with radiotherapy alone, at the U.T. M. D. Anderson Hospital (MDAH), 57 patients with photons alone and 15 patients receiving at least part of the treatment with neutrons using the Texas A&M Variable Energy Cyclotron. There were no significant differences in local control according to tumor size or location, number of previous excisions, but tumor grade was an important prognostic factor. Patients receiving doses of 6100 rad or greater did no better than those receiving 4000 to 6000 rad. The proportion disease-free at 5 years for 12 patients with grade 1 tumors was 58% compared to 32% and 17% for 10 patients with grade 2 and 50 patients with grade 3 respectively. Of the 57 patients treated with photons alone, the proportion disease-free at 5 years was 28%, compared with 80% for patients in whom gross removal of the tumor could be accomplished. Of the 15 patients treated with neutrons, 40% were disease-free at 5 years. Although this improvement in local control with neutrons is not statistically significant because of the size of the groups, further investigation of neutron therapy for nonresectable tumors is indicated.