Outcome of treatment for breast cancer patients with chest wall recurrence according to initial stage: Implications for post-mastectomy radiation therapy

Background and PurposeOptimal radiation target volumes for breast cancer patients with their first isolated chest wall recurrence (ICWR) after mastectomy are controversial. We aimed to analyze the regional failure patterns and to investigate the role of prophylactic regional nodal irradiation (RNI) for ICWR.Materials and MethodsAltogether 205 patients with ICWR after mastectomy were retrospectively analyzed. Post-recurrence progression-free survival (PFS) and overall survival (OS) rates were calculated by Kaplan-Meier method and the differences were compared with Log-rank test. Competing risk model was used to estimate the subsequent regional recurrence (sRR) and locoregional recurrence (sLRR) rates, and the differences were compared with Gray test.ResultsThe 5-year sRR rate was 25.2% with median follow-up of 88.6 months. Of the 52 patients with sRR, 30 (57.7%) recurred in the axilla, 29 (55.8%) in supraclavicular fossa (SC), and five (9.6%) in internal mammary nodes. Surgery plus radiotherapy was independently associated with better sLRR and PFS rates (p<0.001). The ICWR interval of ≤ 4 years was associated with unfavorable sRR (p=0.062), sLRR (p=0.014), PFS (p=0.001), and OS (p=0.005). Among the 157 patients who received radiotherapy after ICWR, chest wall plus RNI significantly improved PFS (p=0.004) and OS (p=0.021) compared with chest wall irradiation alone. In the 166 patients whose ICWR interval was ≤ 4 years, chest wall plus RNI provided the best PFS (p<0.001) and OS (p=0.022) compared with chest wall irradiation alone or no radiotherapy.ConclusionPatients with ICWR have a high-risk of sRR in SC and axilla. Chest wall plus RNI is recommended.

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A Pilot Randomized Clinical Study of the Additive Treatment Effect of Photodynamic Therapy in Breast Cancer Patients with Chest Wall Recurrence

Journal of Breast Cancer ◽

10.4048/jbc.2014.17.2.161 ◽

2014 ◽

Vol 17 (2) ◽

pp. 161 ◽

Cited By ~ 15

Author(s):

Yan Liu ◽

Guofang Hou ◽

Xiaobei Zhang ◽

Jing Jing Liu ◽

Sheng Zhang ◽

...

Keyword(s):

Breast Cancer ◽

Photodynamic Therapy ◽

Clinical Study ◽

Cancer Patients ◽

Chest Wall ◽

Treatment Effect ◽

Breast Cancer Patients ◽

Randomized Clinical Study ◽

Chest Wall Recurrence ◽

Additive Treatment

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The Prognostic Value of Skin Involvement in Breast Cancer Patients With Chest Wall Recurrence

10.21203/rs.3.rs-512385/v1 ◽

2021 ◽

Author(s):

Danyang Zhou ◽

Mei Li ◽

Fei Xu ◽

Qiufan Zheng ◽

Qianyi Lu ◽

...

Keyword(s):

Breast Cancer ◽

Disease Progression ◽

Cancer Patients ◽

Chest Wall ◽

Female Breast Cancer ◽

Nodal Status ◽

Skin Involvement ◽

Breast Cancer Patients ◽

Female Breast ◽

Chest Wall Recurrence

Abstract Background: To assess the prognosis of skin involvement in female breast cancer patients with chest wall recurrence (CWR).Methods: We retrospectively analyzed the clinical-pathological data of breast cancer patients with CWR who were diagnosed pathologically between January 2000 and April 2020. Progression free survival (PFS) was defined as time from diagnosis of CWR to the first disease progression. Persistent chest wall progression was three consecutive chest wall progression without distant organ involvement.Results: A total of 476 patients with CWR were included in this study. Among them, skin involvement or not was queried and confirmed in 345 patients. Skin involvement was significantly correlated to tumor size (P=0.003) and initial nodal status (P<0.001). By Kaplan-Meier analysis, skin involvement predicted a shorter PFS (P<0.001), especially local disease progression (P<0.001). Skin involvement was an independent biomarker for PFS by the multivariate analysis (P=0.034). Patients with skin involvement were more likely to experience persistent chest wall progression (P=0.040). After eliminating the potential deviation caused by insufficient follow-up time, persistent chest wall progression was more likely to be associated with positive lymph nodal status (P=0.046), negative PR (P=0.001) and positive HER2 (P=0.046) of the primary site, negative ER (P=0.027) and PR (P=0.013) of chest wall lesion and skin involvement (P=0.020).Conclusion: Skin involvement predicted poor local disease control in female breast cancer patients with CWR and it was more likely to be related to persistent chest wall progression. We improved the stratification of prognosis and provided new insights for biological behaviors of the disease and further individualized treatment in breast cancer patients with CWR.

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Chest wall recurrence in pT1-2N0-1 breast cancer patients after mastectomy without radiotherapy

Breast Cancer Research and Treatment ◽

10.1007/s10549-018-4707-0 ◽

2018 ◽

Vol 169 (3) ◽

pp. 507-512 ◽

Cited By ~ 3

Author(s):

Ji Hyun Chang ◽

Kyung Hwan Shin ◽

Seung Do Ahn ◽

Hae Jin Park ◽

Eui Kyu Chie ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Chest Wall ◽

Breast Cancer Patients ◽

Chest Wall Recurrence

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Continuous low-irradiance photodynamic therapy (CLIPT) as a novel treatment for cutaneous recurrences of breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e11548 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e11548-e11548

Author(s):

Justin Persico ◽

David E. Wazer ◽

Anne Marie Melanson ◽

Gary S Rogers ◽

Roger Graham

Keyword(s):

Breast Cancer ◽

Photodynamic Therapy ◽

Cancer Patients ◽

Chest Wall ◽

Light Exposure ◽

Tunel Assay ◽

Post Treatment ◽

Breast Cancer Patients ◽

Biopsy Specimens ◽

Chest Wall Recurrence

e11548 Background: Photodynamic therapy (PDT) has been used for the treatment of many malignancies. This binary therapy involves the administration of a photosensitizer followed by exposure to light. Treatment toxicity has historically limited the use of PDT. Our study aimed to assess whether a novel approach, termed continuous low irradiance photodynamic therapy (CLIPT), would result in enhanced efficacy with reduced toxicity. Preclinical data suggest decreased toxicity and increased cell death by apoptosis with CLIPT. Methods: Breast cancer patients with chest wall progression were eligible for our study. No systemic anti-cancer therapy within 30 days and no radiation to the target site within 60 days of enrollment was allowed. All patients received porfirmer sodium intravenous 0.8mg/kg at time 0 and returned at time 48 hours for light exposure. A wavelength of 630nm was delivered continuously over 24 hours by a Diomed laser via a flexible light patch. An area of uninvolved normal skin was used as a control. Post-treatment biopsy was performed to assess for apoptosis by TUNEL assay. Results: Eight breast cancer patients were enrolled in our study. The initial dose of light was 100J/cm2 and was given to subjects 1 and 2 but resulted in partial-thickness ulceration of the epidermis. Subjects 3-8 received light at 50J/cm2 and experienced erythema at the intervention site, with no ulceration observed. All patients reported mild pain at the treatment site and 6 required short-term narcotic analgesia. Five of the 8 patients showed evidence of response, and no patients had progression of treated lesions. Four of 7 biopsy specimens showed evidence of apoptosis on TUNEL assay. Conclusions: CLIPT may prove to be a valuable option for treatment of breast cancer chest wall recurrence. The dose-limiting toxicity was skin ulceration and the maximum tolerated dose (MTD) was determined to be 50J/cm2/24h. A 50% response rate was seen in patients treated at the MTD, with apoptosis seen on post-treatment biopsy specimens. Further investigation of CLIPT as a therapeutic modality is warranted.

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