Long-term radiation sequelae after breast-conserving therapy in women with early-stage breast cancer: an observational study using the LENT-SOMA scoring system.
OBJECTIVE
To evaluate the long-term toxicity after breast-conserving therapy in women with early-stage breast cancer.


METHODS
Late toxicity according to the late effects of normal tissue-subjective, objective, management, and analytic (LENT-SOMA) criteria and cosmetic outcome (graded by physicians) were evaluated in 590 of 2943 women with early-stage breast cancer who were irradiated between 1983 and 1995 using the following fractionation schedules: group A, 1983-1987, 2.5 Gy 4x/wk to 60 Gy; group B, 1988-1993, 2.5 Gy 4x/wk to 55 Gy, group C, 1994-1995, 2.0 Gy 5x/wk to 55 Gy.


RESULTS
LENT-SOMA Grade 3-4 toxicity was observed as follows: group A (median follow-up 171 months; range 154-222 months), fibrosis 16% (7 of 45), telangiectasia 18% (8 of 45), and atrophy 4% (2 of 45); group B (median follow-up 113 months; range 78-164 months), pain 2% (8 of 345), fibrosis 10% (34 of 345), telangiectasia 10% (33 of 345), arm edema 1% (2 of 345), and atrophy 8% (27 of 345); and group C (median follow-up 75 months, range 51-96 months, n = 200), occurrence of Grade 3-4 late morbidity <or=2%. The cosmetic outcome was very good to acceptable in 78% (35 of 45) of patients in group A, 83% (286 of 345) in group B, and 94% (187 of 200) in group C.


CONCLUSIONS
In our population, the long-term side effects after breast-conserving therapy were not rare, but were mainly asymptomatic. The LENT-SOMA breast module is a practical tool to assess radiation-induced long-term toxicity.
Fehlauer
Fabian
F
Department of Radiation Oncology, University Hospital of Hamburg, Hamburg, Germany. fehlauer@uke.uni-hamburg.de
Tribius
Silke
S
Höller
Ulrike
U
Rades
Dirk
D
Kuhlmey
Antje
A
Bajrovic
Amira
A
Alberti
Winfried
W
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001284:Atrophy; D001940:Breast / Q000473:pathology; D001941:Breast Diseases / Q000209:etiology; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D010146:Pain / Q000209:etiology; D011832:Radiation Injuries / Q000150:complications / Q000473:pathology*; D012044:Regression Analysis; D012189:Retrospective Studies