Strahlenther Onkol (2018) 194:206–214
Reirradiation + hyperthermia for recurrent breast cancer en cuirasse
· Rob van Os
· Jack L. Venselaar
Martijn W. Heymans
· Geertjan van Tienhoven
Received: 22 August 2017 / Accepted: 19 November 2017 / Published online: 20 December 2017
© The Author(s) 2017. This article is an open access publication.
Background and purpose Patients with irresectable locoregional recurrent breast cancer en cuirasse (BCEC) do not have
effective curative treatment options. Hyperthermia, the elevation of tumor temperature to 40–45 °C, is a well-established
radio- and chemotherapy sensitizer. A total of 196 patients were treated with reirradiation and hyperthermia (reRT+HT) at
two Dutch institutes from 1982–2005. The palliative effect was evaluated in terms of clinical outcome and toxicity.
Patients and methods All patients received previous irradiation to a median dose of 50 Gy. In all, 75% of patients received
1–6 treatment modalities for previous tumor recurrences. ReRT consisted of 8 × 4 Gy given twice a week or 12 × 3 Gy
given four times a week. Superﬁcial hyperthermia was added once or twice a week. Tumor area comprised ≥½ofthe
ipsilateral chest wall.
Results Overall clinical response rate was 72% (complete response [CR] 30%, partial response [PR] 42%, stable disease
[SD] 22%, progressive disease [PD] 6%). The local progression-free rate at 1 year was 24%. Median survival was
6.9 months. Forty-three percent of our patients with CR, PR, SD after treatment remained inﬁeld progression-free until
death or last follow-up. Acute ≥grade 3 toxicity occurred in 33% of patients, while late ≥grade 3 toxicity was recorded in
14% of patients. Tumor ulceration prior to treatment had a negative impact on both clinical outcome and toxicity.
Conclusion ReRT+HT provides sustainable palliative tumor control, despite refractory, extensive tumor growth. Compared
to currently available systemic treatment options, reRT+HT is more effective with less toxicity.
Keywords Treatment outcome · Hyperthermia, induced · Palliation · Radiation-sensitizing agents · Drug-related side
effects and adverse reactions
Electronic supplementary material The online version of this
article (https://doi.org/10.1007/s00066-017-1241-7) contains
supplementary material, which is available to authorized users.
Sabine Oldenborg, M.Sc.
Department of Radiation Oncology, Z1-215, Academic
Medical Center, University of Amsterdam (AMC),
Meibergdreef 9, P.O. Box 22660, Amsterdam, The
Department of Radiation Oncology, Institute Verbeeten
(BVI), Tilburg, The Netherlands
Department of Epidemiology and Biostatistics, VU
University Medical Center, Amsterdam, The Netherlands