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What is the optimal/safest regimen for re-irradiation of a partial chest wall following surgical resection of an isolated chest wall recurrence?
Is there any literature supporting that a gentle fractionation/bid regimen (i.e., 1.5Gy bid x 30 = 45Gy) is safer than a standard fractionation (i.e., 2Gy daily x 25 = 50Gy)? Thoughts from anecdotal experience are welcomed as well!
Answer from: Radiation Oncologist at Community Practice
I agree with Ben that this is a difficult scenario. Resection with new tissue is ideal, but cannot always be done. Removal of the gross disease with some type of resection is also optimal if possible. Use of chemotherapy for isolated chest wall recurrence is controversial, but is often d...
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Answer from: Radiation Oncologist at Academic Institution
This is a tough situation. To my knowledge, the available literature on reirradiation of the chest wall is relatively uniformative, with short follow up. I recall seeing a patient who came to our institution after full dose reirradiation of the left chest wall which was complicated by soft tiss...
Answer from: Radiation Oncologist at Community Practice
I agree with the above, with our approach being very similar. Additional measures we would take would be to have a complete conformal block for the heart and consider Trental as a prophylaxis during and after RT (some data suggests it reduces fibrosis).
In our experience, almost all of these p...
Answer from: Radiation Oncologist at Academic Institution
With respect to reirradiaton for chest wall recurrence of breast cancer, I offer the following comments:
1) I would be reluctant to reirradiate "prophylactically" in the setting of a resected isolated small chest wall recurrence. It's different when there is clinically evident unresect...