Cellulitis of the breast as a complication of breast-conserving surgery and irradiation.
Breast-conserving therapy (BCT) has become a standard treatment option for patients with early-stage breast cancer. We have observed cellulitis of the treated breast as a complication occurring before, during, and after breast irradiation. The cases of five women (median follow-up, 28 months; range, 24-65 months) who developed cellulitis before (n = 1), during (n = 2), or after (n = 2) breast irradiation were reviewed. A consecutive series of BCT patients at Emory University was reviewed to determine the incidence of this complication. Four of five women had an axillary dissection, yielding a median of 14 negative lymph nodes (range, 6-22 nodes). Two of four patients developed axillary seromas requiring aspiration. In these four patients, only the breast was irradiated. A fifth patient had no axillary dissection and had breast and supraclavicular/axillary irradiation. The median whole breast dose was 50 Gy (range, 46-50.4 Gy). The clinical features of cellulitis included erythema, edema, tenderness, and warmth in all patients. Cellulitis was a relapsing problem for four of the five patients. The incidence of this complication in our series of BCT patients was approximately 1%. Cellulitis in the ipsilateral breast can be a relapsing complication of BCT and can be seen before, during, or after breast irradiation. Axillary seromas and aspiration seem to indicate a subset of patients at risk of early cellulitis. Late cellulitis may be caused by a variety of factors related to modifications of vascular and skin integrity by surgery and radiotherapy. Prompt diagnosis and appropriate antibiotic therapy is recommended. This problem need not interrupt a course of breast irradiation, and does not necessarily lead to a poor cosmetic result.
Hughes
L L
LL
Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.
Styblo
T M
TM
Thoms
W W
WW
Schwarzmann
S W
SW
Landry
J C
JC
Heaton
D
D
Carlson
G W
GW
Wood
W C
WC
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001365:Axilla / Q000473:pathology; D001940:Breast / Q000528:radiation effects*; D001941:Breast Diseases / Q000188:drug therapy / Q000209:etiology*; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy* / Q000601:surgery; D002481:Cellulitis / Q000188:drug therapy / Q000209:etiology*; D003560:Cysts / Q000209:etiology / Q000628:therapy; D004487:Edema / Q000209:etiology; D004890:Erythema / Q000209:etiology; D005122:Exudates and Transudates; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000009:adverse effects; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D019152:Paracentesis; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012008:Recurrence; D012881:Skin Temperature
D000900:Anti-Bacterial Agents