Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Jul 24, 2019; 10(7): 256-268
Published online Jul 24, 2019. doi: 10.5306/wjco.v10.i7.256
Reirradiation of recurrent breast cancer with proton beam therapy: A case report and literature review
Yi-Lan Lin
Yi-Lan Lin, Department of Radiation Oncology, Rinecker Proton Therapy Center, Munich 81371, Germany
Author contributions: Lin YL performed all the research and interpretive functions for this case report.
Supported by Rinecker Proton Therapy Center, Munich, Germany.
Informed consent statement: After contacting the patient about the planned publication of her case, she provided written authorization.
Conflict-of-interest statement: The author states there are no potential conflicts of interest relevant to this publication.
CARE Checklist (2016) statement: The author has read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Yi-Lan Lin, Chief Physician, Department of Radiation Oncology, Rinecker Proton Therapy Center, Schaeftlarnstr. 133, Munich 81371, Germany.
Telephone: +49-89-724670 Fax: +49-89-72467352
Received: February 8, 2019
Peer-review started: February 12, 2019
First decision: June 7, 2019
Revised: June 22, 2019
Accepted: July 22, 2019
Article in press: July 22, 2019
Published online: July 24, 2019

Locoregional recurrence of breast cancer is challenging for clinicians, due to the various former treatments patients have undergone. However, treatment of the recurrence with systemic therapy and subsequent reirradiation of chest wall is accompanied by increased toxicities, particularly radiation-induced cardiovascular disease. Reirradiation by proton beam therapy (PBT) enables superior preservation of adjacent organs at risk as well as concurrent dose escalation for delivery to the gross tumor. This technology is expected to improve the overall outcome of recurrent breast cancer.


A 47-year-old female presented with an extensive locoregional recurrence at 10 yr after primary treatment of a luminal A breast cancer. Because of tumor progression despite having undergone bilateral ovarectomy and systemic therapy, the patient was treated with PBT BE total dose of 64.40 Gy to each gross tumor and 56.00 Gy to the upper mediastinal and retrosternal lymphatics including the entire sternum in 28 fractions. Follow-up computed tomography showed a partial remission, without evidence of newly emerging metastasis. At 19 mo after the PBT, the patient developed a radiation-induced pericardial disease and pleural effusions with clinical burden of dyspnea, which were successfully treated by drainage and corticosteroid. Cytological analysis of the puncture fluid showed no malignancy, and the subsequent computed tomography scan indicated stable disease as well as significantly decreased pericardial and pleural effusions. The patient remains free of progression to date.


PBT was a safe and effective method of reirradiation for locoregionally recurrent breast cancer in our patient.

Keywords: Proton beam therapy, Recurrent breast cancer, Chest wall recurrence, Reirradiation, Pericarditis, Radiation-induced cardiovascular disease, Case report

Core tip: The treatment of recurrent breast cancer is very complex and not standardized. Patients with locoregional recurrence and gross residual tumor despite systemic therapy and surgery demand further options with potentially curative intention. Presented here is a patient with a late locoregionally recurrent breast cancer, showing significant reduction of gross tumor disease after reirradiation by proton beam therapy. In the 2 years since, the patient has remained free of tumor progression.