11027 Background: Chest wall recurrences are seen despite postoperative chemotherapy and radiotherapy. For patients with unresectable lesions who have previously received radiotherapy no standard treatment is available. We devised a protocol of low dose gemcitabine as radiosensitizer concurrent with low dose of radiation and conducted this study with the objectives to document the efficacy and toxicity of this protocol. Methods: From January 2003 to August 2005, 48 patients were included in this study. A histopthological or cytological evidence of chest wall recurrence was required. Females between 18–70 years, with previous modified radical mastectomy, post operative radiation and adjuvant chemotherapy were included. Patients with metastatic disease were excluded. Written informed consent was obtained. A dose of 150 mg / m2 of gemcitabine in 200 ml of normal saline was infused in 2 hour on day 1, 8, 15 and 22 of radiation. Radiation was delivered 2 hours after the completion of infusion. Conventional fractionation was used to deliver a total dose of 36 Gy given in 3.5 weeks. RECIST and RTOG criteria were used. Results: Twenty recurrences were related to the scar, 10 to the involved internal mammary lymph node region invading sternum and ribs and 18 were associated with the soft tissue masses outside the scar area. All patients were evaluable for response and toxicity. Complete response was seen in 6 (12.5 %) patients, (95 % CI, 13.87_37.16), partial response was seen in 30 (62.5 %) (95 % CI, 44.92 -71.40) with an over all response rate of 75 % (95 % CI, 70.57—91.40) Stable disease was seen in 9 (18.8 %) patients and disease progression in 3 (6.3 %) patients. Grade I skin reaction was seen in 15 (31.2 % ) patients grade II in 11 ( 22.9 % ) and grade III in 3 ( 6.3 % ) patients. No systemic toxicity was seen. Conclusions: Low dose gemcitabine and concurrent radiotherapy is a reasonable salvage treatment in chest wall recurrence in breast cancer patients who have previously received adjuvant chemotherapy and full dose of radiotherapy. This approach has acceptable toxicity. No significant financial relationships to disclose.
Patterns of Chest Wall Recurrence and Suggestions on the Clinical Target Volume of Breast Cancer: A Retrospective Analysis of 121 Postmastectomy Patients
