What is your strategy and evidence to use hyperthermia and/or chemotherapy with radiation for recurrent breast cancer?

When dealing with recurrent breast cancer and considering re-irradiation several factors need to be evaluated:

1. Is the patient metastatic- deciding on local therapy for palliation or more aggressive treatment for local only recurrence

2. How much previous dose and to what regions.

I offer patients several options depending on clinical scenario:

1. If post-mastectomy with no reconstruction, I will consider re-irradiation with hypofractionation. A recent review in the red journal provides good data....

I have used pulsed dose rate external beam (no hyperthermia) several times for chest wall retreatment with good results where 20 cGy is delivered every 3 minutes. There is a long history of this type of technique in France and England by JJ Mazeron and others.