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Bakker A, Tello Valverde CP, van Tienhoven G, et al. Post-operative re-irradiation with hyperthermia in locoregional breast cancer recurrence: Temperature matters. Radiother Oncol. 2021;167:149-157doi: 10.1016/j.radonc.2021.12.036.
Bakker, A., Tello Valverde, C. P., van Tienhoven, G., Kolff, M. W., Kok, H. P., Slotman, B. J., Konings, I. R. H. M., Oei, A. L., Oldenburg, H. S. A., Rutgers, E. J. T., Rasch, C. R. N., van den Bongard, H. J. G. D., & Crezee, H. (2021). Post-operative re-irradiation with hyperthermia in locoregional breast cancer recurrence: Temperature matters. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 167149-157. https://doi.org/10.1016/j.radonc.2021.12.036
Bakker, Akke, et al. "Post-operative re-irradiation with hyperthermia in locoregional breast cancer recurrence: Temperature matters." Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology vol. 167 (2021): 149-157. doi: https://doi.org/10.1016/j.radonc.2021.12.036
Bakker A, Tello Valverde CP, van Tienhoven G, Kolff MW, Kok HP, Slotman BJ, Konings IRHM, Oei AL, Oldenburg HSA, Rutgers EJT, Rasch CRN, van den Bongard HJGD, Crezee H. Post-operative re-irradiation with hyperthermia in locoregional breast cancer recurrence: Temperature matters. Radiother Oncol. 2021 Dec 29;167:149-157. doi: 10.1016/j.radonc.2021.12.036. Epub 2021 Dec 29. PMID: 34973278.
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Radiother Oncol. 2021 Dec 29;167:149-157. doi: 10.1016/j.radonc.2021.12.036. Epub 2021 Dec 29.

Post-operative re-irradiation with hyperthermia in locoregional breast cancer recurrence: Temperature matters.

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

Akke Bakker, C Paola Tello Valverde, Geertjan van Tienhoven, M Willemijn Kolff, H Petra Kok, Ben J Slotman, Inge R H M Konings, Arlene L Oei, Hester S A Oldenburg, Emiel J T Rutgers, Coen R N Rasch, H J G Desirée van den Bongard, Hans Crezee

Affiliations

  1. Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: [email protected].
  2. Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: [email protected].
  3. Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: [email protected].
  4. Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: [email protected].
  5. Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: [email protected].
  6. Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: [email protected].
  7. Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: [email protected].
  8. Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: [email protected].
  9. Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands. Electronic address: [email protected].
  10. Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands. Electronic address: [email protected].
  11. Department of Radiation Oncology, LUMC, Leiden, the Netherlands. Electronic address: [email protected].
  12. Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: [email protected].
  13. Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: [email protected].

PMID: 34973278 DOI: 10.1016/j.radonc.2021.12.036

Abstract

PURPOSE: To investigate the impact of hyperthermia thermal dose (TD) on locoregional control (LRC), overall survival (OS) and toxicity in locoregional recurrent breast cancer patients treated with postoperative re-irradiation and hyperthermia.

METHODS: In this retrospective study, 112 women with resected locoregional recurrent breast cancer treated in 2010-2017 with postoperative re-irradiation 8frx4Gy (n = 34) or 23frx2Gy (n = 78), combined with 4-5 weekly hyperthermia sessions guided by invasive thermometry, were subdivided into 'low' (n = 56) and 'high' TD (n = 56) groups by the best session with highest median cumulative equivalent minutes at 43 °C (Best CEM43T50) < 7.2 min and ≥7.2 min, respectively. Actuarial LRC, OS and late toxicity incidence were analyzed. Backward multivariable Cox regression and inverse probability weighting (IPW) analysis were performed.

RESULTS: TD subgroups showed no significant differences in patient/treatment characteristics. Median follow-up was 43 months (range 1-107 months). High vs. low TD was associated with LRC (p = 0.0013), but not with OS (p = 0.29) or late toxicity (p = 0.58). Three-year LRC was 74.0% vs. 92.3% in the low and high TD group, respectively (p = 0.008). After three years, 25.0% and 0.9% of the patients had late toxicity grade 3 and 4, respectively. Multivariable analysis showed that distant metastasis (HR 17.6; 95%CI 5.2-60.2), lymph node involvement (HR 2.9; 95%CI 1.2-7.2), recurrence site (chest wall vs. breast; HR 4.6; 95%CI 1.8-11.6) and TD (low vs. high; HR 4.1; 95%CI 1.4-11.5) were associated with LRC. TD was associated with LRC in IPW analysis (p = 0.0018).

CONCLUSIONS: High thermal dose (best CEM43T50 ≥ 7.2 min) was associated with significantly higher LRC for patients with locoregional recurrent breast cancer treated with postoperative re-irradiation and hyperthermia, without augmenting toxicity.

Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.

Keywords: Dose-effect relationship; Hyperthermia; Inverse probability weighting; Locoregional control; Locoregional recurrent breast cancer; Propensity score; Re-irradiation; Thermal dose; Toxicity

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