title: Partial breast irradiation in a patient with bilateral breast cancers and CREST syndrome.
abstract: OBJECTIVE
  To describe the first documented use of partial breast irradiation (PBI) in a patient with calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias (CREST) syndrome.
  
  
  METHODS
  A 50-year-old woman with well-controlled CREST syndrome for 6 years was diagnosed with bilateral early-staged breast cancers. She underwent bilateral lumpectomies, sentinel lymph node biopsies, and PBI delivered via bilateral MammoSite catheters (Cytyc Corp., Marlborough, MA) followed by chemotherapy. She was monitored perioperatively, at 6 months and at 1 year for worsening of her CREST-related symptoms and complications associated with surgery and radiation therapy. Both surgeon and patient's opinion of her cosmetic outcome were also recorded at 1-year followup.
  
  
  RESULTS
  The patient experienced mild acute cellulitic changes in the perioperative period, which resolved with antibiotics. At 6 months, she exhibited a Grade 1 late toxicity, which has remained stable at 1-year followup. The patient and surgeon are very pleased with her cosmetic outcome.
  
  
  CONCLUSIONS
  Accelerated PBI was delivered safely to a patient with collagen vascular disease. By decreasing the surface area receiving radiation with accelerated PBI, we believe that the toxicity associated with the treatment was minimized. Future studies will be necessary to clarify the use of PBI in patients with collagen vascular disease.
authors.affiliation: Department of Surgery, University of Colorado Medical Center, Aurora, CO 80045, USA. nicole.kounalakis@ucdenver.edu
authors.forename: Nicole
authors.initials: N
authors.lastname: Kounalakis
authors.forename: Richard
authors.initials: R
authors.lastname: Pezner
authors.forename: Cecil L
authors.initials: CL
authors.lastname: Staud
authors.forename: Laura
authors.initials: L
authors.lastname: Kruper
mesh_terms: D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy* / Q000601:surgery; D017675:CREST Syndrome / Q000453:epidemiology*; D018270:Carcinoma, Ductal, Breast / Q000453:epidemiology* / Q000532:radiotherapy*; D002404:Catheterization; D015897:Comorbidity; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant