Use of perioperative or split-course interstitial brachytherapy techniques for salvage irradiation of isolated local recurrences after conservative management of breast cancer

Treatment of local recurrence after conservative management for breast cancer is mastectomy. When mastectomy is contraindicated or refused, could brachytherapy be a therapeutic alternative for such isolated local relapses (ILR)? From February 1977 to June 1990, 38 patients, previously treated by radiation therapy or by a combination of radiotherapy and surgery for breast cancer, underwent salvage brachytherapy for an ILR. Fifteen patients were treated by limited tumorectomy plus 30 Gy perioperative brachytherapy for a 2.4-cm mean diameter IRL (Group A). Twenty-three patients were treated by exclusive split-course brachytherapy, delivering 60-70 Gy by two implants at 1-month interval, for a 3.9-cm mean diameter IRL (Group B). All patients achieved a clinical complete response after treatment. With a mean follow-up of 40 +/- 24 months, eight patients (21%) experienced local relapse between 9 and 48 months (four patients in Groups A and B). This second local recurrence was isolated in one case and was associated with metastatic disease in seven cases. At 5 years, overall survival was 55% (61% for Group A and and 50% for Group B). Three patients developed local complications requiring mastectomy (skin necrosis, two patients; severe breast pain, one patient). Cosmetic results in locally controlled patients were good in four patients, acceptable in twelve patients, mediocre in nine patients, and nonvaluable in two patients. Both perioperative brachytherapy and exclusive split-course brachytherapy appear to be feasible techniques and may be used occasionally as an alternative therapy to radical mastectomy for ILR.