Fat necrosis after conserving surgery and interstitial brachytherapy and/or external-beam irradiation in women with breast cancer.
OBJECTIVE
To investigate the incidence of fat necrosis, breast tissue fibrosis and breast pain after conserving surgery and accelerated partial-breast irradiation (APBI, group A), whole-breast external-beam irradiation (EBRT, group B), or EBRT combined with an interstitial boost (EBIB, group C) in women with breast cancer.


METHODS
85 patients who received breast-conserving therapy from 02/2000 to 03/2002 were analyzed. 30 patients received EBRT, 33 patients APBI, and 22 patients EBIB. Median follow-up was 35.5, 35.0, and 37.5 months, respectively. Fat necrosis was detected and rated by mammograms, fibrosis and pain were clinically rated with the LENT-SOMA scores.


RESULTS
The incidence of fat necrosis was 15.3% for all patients; and 15.2%, 20.0%, and 9.0% for groups A, B, and C, respectively. The 3-year fat necrosis-free survival probability was 83%, 76%, and 95% (difference not significant). The mean time to first diagnosis of fat necrosis was 25.6, 26.2, and 26.0 months. No patient needed surgical intervention because of fat necrosis-related pain. Fibrosis was present in 27.3%, 63.3%, and 77.3% (p < 0.001), breast pain in 9.0%, 33.4%, and 18.1% (p < 0.05).


CONCLUSIONS
Asymptomatic fat necrosis is a common finding after both percutaneous and interstitial irradiation after breast-conserving surgery. This analysis did not support the hypothesis that APBI with multicatheter implants leads to higher rates of fat necrosis, fibrosis, or pain.
Ott
Oliver J
OJ
Department of Radiation Oncology, University Hospital, Erlangen, Germany. oliver.ott@strahlen.imed.uni-erlangen.de
Schulz-Wendtland
Ruediger
R
Uter
Wolfgang
W
Pfahlberg
Annette
A
Beckmann
Matthias W
MW
Sauer
Rolf
R
Strnad
Vratislav
V
D000273:Adipose Tissue / Q000473:pathology* / Q000528:radiation effects; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009336:Necrosis; D009367:Neoplasm Staging; D010146:Pain; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013997:Time Factors