Locoregional recurrences following radical external beam irradiation and interstitial implantation for operable XXXX --a twenty three year experience.

@entity1 @entity8034 @entity0 @entity5 @entity3
Locoregional recurrences are reported in 493 consecutive with T1 T2 N0 N1 @entity0 @entity1 who were treated with radical external beam irradiation and interstitial 192 Ir. implant between 1961 and 1979. Follow-up ranges from 5-23 years (mean 10 years) with 195 @entity1 having 10-23 years follow up (mean 12 years). Tumorectomy was performed in 130/158 (88%) @entity8034 (22%) T2 @entity1 . There were 51 (10%) locoregional recurrences with 34 mammary, 14 combined mammary/axillary and 3 isolated axillary recurrences. The 10 year relapse rate was 20/195 (10%). The risk, timing and site of relapse varied according to TNM stage and tumorectomy. The risk was higher for T2 (42/335, 12.5%) than T1 (9/158, 5.5%) due to a larger number of recurrences occurring in the first 5 years (T2 32/335, 9.5% vs T1 4/158, 2.5%). Between 5-10 years, risk of relapse equalized to around 3% for both groups and only 1 relapse was seen after 10 years. Of the 48 mammary recurrences, 25 (52%) occurred in the implant volume, 7 (14%) occurred on the margin of the implant, 12 (25%) occurred at sites remote from the primary and in 4 (9%), the exact site could not be defined. 14/48 mammary recurrences were accompanied by axillary relapse, there were 3 isolated axillary recurrences and supraclavicular @entity3 accompanied axillary relapse in 3 cases. The overall risk, of axillary relapse was 3% (17/493) and there was significant correlation with @entity5 . Salvage surgery generally mastectomy and axillary dissection, was possible in 45/51 (90%) recurrences. 23/45 (50%) survive NED 0.2-9 years (mean 3 years) after salvage. 8/23 (35%) followed longer than 5 years after salvage survive NED. Our results have been compared with other series in the literature and changes in our current protocol are described.
