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Open Access 01-04-2016 | Original Article

Rib fractures after reirradiation plus hyperthermia for recurrent breast cancer

Predictive factors

Authors: Sabine Oldenborg, M.Sc., Christel Valk, B.Sc., Rob van Os, M.Sc., Bing Oei, M.Sc., Jack Venselaar, PhD., Paul Zum Vörde Sive Vörding, Adriënne van Randen, Ph.D., Hans Crezee, Ph.D., Geertjan van Tienhoven, Ph.D., Coen Rasch, Ph.D.

Published in: Strahlentherapie und Onkologie | Issue 4/2016

Abstract

Background

Combining reirradiation (reRT) and hyperthermia (HT) has shown high therapeutic value for patients with locoregional recurrent breast cancer (LR). However, additional toxicity of reirradiation (e.g., rib fractures) may occur. The aim of this study is to determine the impact of potential risk factors on the occurrence of rib fractures.

Patients and methods

From 1982–2005, 234 patients were treated with adjuvant reRT + HT after surgery for LR. ReRT consisted typically of 8 fractions of 4 Gy twice a week, or 12 fractions of 3 Gy four times a week. A total of 118 patients were irradiated with abutted photon and electron fields. In all, 60 patients were irradiated using either one or alternating combinations of abutted AP electron fields. Hyperthermia was given once or twice a week.

Results

The 5-year infield local control (LC) rate was 70 %. Rib fractures were detected in 16 of 234 patients (actuarial risk: 7 % at 5 years). All rib fractures occurred in patients treated with a combination of photon and abutted electron fields (p = 0.000); in 15 of 16 patients fractures were located in the abutment regions. The other significant predictive factors for rib fractures were a higher fraction dose (p = 0.040), large RT fields, and treatment before the year 2000.

Discussion and conclusion

ReRT + HT results in long-term LC. The majority of rib fractures were located in the photon/electron abutment area, emphasizing the disadvantage of field overlap. Large abutted photon/electron fields combined with 4 Gy fractions increase the number of rib fractures in this study group. However, as these factors were highly correlated no relative importance of the individual factors could be estimated. Increasing the number of HT sessions a week does not increase the risk of rib fractures.

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Title: Rib fractures after reirradiation plus hyperthermia for recurrent breast cancer
Predictive factors
Authors: Sabine Oldenborg, M.Sc.
Christel Valk, B.Sc.
Rob van Os, M.Sc.
Bing Oei, M.Sc.
Jack Venselaar, PhD.
Paul Zum Vörde Sive Vörding
Adriënne van Randen, Ph.D.
Hans Crezee, Ph.D.
Geertjan van Tienhoven, Ph.D.
Coen Rasch, Ph.D.
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 4/2016
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-016-0946-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Rib fractures after reirradiation plus hyperthermia for recurrent breast cancer

Predictive factors

Abstract

Background

Patients and methods

Results

Discussion and conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and methods

Results

Discussion and conclusion

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