wIRA-hyperthermia plus re-irradiation in the management of unresectable locally recurrent breast cancer

Introduction: Management of locally recurrent breast cancer (LRBC) remains a therapeutical challenge, especially in cases of unresectable lesions and when prior radiotherapy was included. Re-irradiation (re-RT) combined with superficial hyperthermia (sHT) adds to options for therapeutic consideration. LRBC in pre-irradiated areas extends from microscopic disease and small lesions in patients to be treated with curative intent up to cancer en cuirasse, where palliative treatment might deliberately be restricted to areas directly affecting quality of life. Hyperthermia as a potent radiosensitizer allows for a reduction of radiotherapy dosage and opens a chance to achieve complete and partial responses even in patients where the aim of tumor control had already been abandoned.

 

On the basis of findings from earlier studies using hyperthermia and re-irradiation, we found that the combination with hyperthermia allowed for a reduction of the total re-irradiation dose to just 20 Gy using a hypofractionated schedule of 5 × 4 Gy once per week.2 To our knowledge, this is the lowest total re-irradiation dose applied so far in a protocol that aims for effective tumor control. The use of a novel technique of contact-free, thermography-controlled water-filtered infrared-A superficial hyperthermia (39-43°C) allows us to cover large-size lesions and could reduce the risk of thermal skin damage to a minimum.3 In contrast to most reported protocols of radiotherapy and hyperthermia combined, we perform hyperthermia immediately before re-irradiation. Low toxicity of this protocol even allows us to repeat re-irradiation using the same dosage and schedule. This is especially crucial in the management of lymphangitis carcinomatosa, which is often recurring. Results were recently published4 for tumor response, local control, and overall survival of 201 patients, including a new classification of tumor size in LRR of breast cancer. There has been a lack of clear definition of tumor extension, which is a distinct criterion for prognosis. The suggested definition of five size classes of local recurrences could help with comparison of data from different protocols and studies using combined hyperthermia and re-irradiation.

Author(s): Markus Notter

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