Salvage Perioperative Interstitial High-Dose-Rate Interventional Radiotherapy (Brachytherapy) for Local Recurrences of the Chest Wall Following Mastectomy and Previous External Irradiation

SIMPLE SUMMARY: Breast cancer patients who were treated with mastectomy and postoperative external irradiation may suffer from tumor relapse in the chest wall. The local treatment of such conditions prevents complications such as ulceration, bleeding, infection, offensive odor, and major psychological stress. In this study, we investigated an approach combining both surgical removal of the tumor and implanting plastic tubes for postoperative interventional radiotherapy in the operated regions. After accurate and personalized computer-based 3-dimensional planning, a small computer remoted radioactive source is introduced through the tubes to re-irradiate the operated region. The procedure led to local control of the tumor in 82% of the patients in five years. A few patients (8.9%) suffered from severe but manageable complications during the follow-up period. We believe that this perioperative and interdisciplinary treatment may be a valid option to help locally recurrent and previously irradiated breast cancer patients as it offers good oncological results and a low rate of severe complications. ABSTRACT: (1) Background: To investigate the technical feasibility, safety, and efficacy of interstitial perioperative high-dose-rate interventional radiotherapy (HDR-IRT, brachytherapy) as a local salvage treatment combined with surgery for local chest wall recurrences following mastectomy and subsequent external beam radiation treatment (EBRT). (2) Methods: A retrospective analysis of 56 patients treated with interstitial HDR-IRT in combination with local surgery of a chest wall recurrence of breast cancer after previous treatment with mastectomy and EBRT from 2008 to 2020. (3) Results: Local recurrence following HDR-IRT was encountered in seven (12.5%) patients. The 1-year local recurrence-free survival (RFS), 3-year RFS, and 5-year RFS were 91%, 82%, and 82%, respectively. The 1-year overall survival (OS), 3-year OS, and 5-year OS was 85.5%, 58%, and 30%, respectively. Acute grade 1–2 radiation dermatitis was observed in 22 (39.3%) patients. Late ≥grade 3 toxicities were encountered in five (8.9%) patients. (4) Conclusions: Salvage perioperative interstitial high-dose-rate interventional radiotherapy (brachytherapy) combined with surgery seems to be an effective interdisciplinary management with acceptable treatment-related toxicity for local recurrences of the chest wall following mastectomy and previous external irradiation.