DEGRO practical guidelines for radiotherapy of breast cancer VI: therapy of locoregional breast cancer recurrences

• DOI: 10.1007/s00066-015-0939-7
• Publication Date: 2016-03-01T08:00:05Z
• Authors: Wolfgang Harms; W. Budach; J. Dunst; P. Feyer; R. Fietkau; W. Haase; D. Krug; M. D. Piroth; M.-L. Sautter-Bihl; F. Sedlmayer; R. Souchon; F. Wenz; R. Sauer
• Keywords: Systemic therapy; Breast-conserving surgery

Abstract Objective To update the practical guidelines for radiotherapy of patients with locoregional breast cancer recurrences based on current German interdisciplinary S3 2012. Methods A comprehensive survey literature using search phrases “locoregional recurrence”, “chest wall “local “regional and “breast cancer” was performed, limits “clinical trials”, “randomized “meta-analysis”, “systematic review”, “guidelines”. Conclusions Patients isolated in-breast or regional should be treated curative intent. Mastectomy is standard care ipsilateral tumor recurrence. In a subset patients, second conservation followed by partial irradiation (PBI) an appropriate alternative to mastectomy. If additional mandatory. The largest reirradiation experience base exists multicatheter brachytherapy; however, prospective clinical trials are needed clearly define selection criteria, long-term local control, toxicity. Following primary mastectomy, resectable receive multimodality therapy including systemic therapy, surgery, radiation +/− hyperthermia. This approach results in high control rates survival achieved patients. radiation-naive unresectable recurrences, previously irradiated risk recurrence after surgical resection strongly considered. Indication dose concepts depend time interval first radiotherapy, presence late effects, concurrent sequential treatment. Combination hyperthermia can further improve control. axillary supraclavicular recurrence, durable disease best surgery radiotherapy. Radiation significantly improves applied whenever feasible.