Skip to main content
Erschienen in: Annals of Surgical Oncology 5/2017

16.11.2016 | Radiation Oncology

Risk Factors Leading to Complications in Early-Stage Breast Cancer Following Breast-Conserving Surgery and Intraoperative Radiotherapy

verfasst von: Sunpreet Rakhra, MD, Kevin Bethke, MD, Jonathan Strauss, MD, MBA, John P. Hayes, MD, Nora Hansen, MD, Seema A. Khan, MD, Irene Helenowski, PhD, Eric D. Donnelly, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 5/2017

Einloggen, um Zugang zu erhalten

Abstract

Objective

The aim of this study was to evaluate outcomes after breast-conserving surgery (BCS) and intraoperative radiotherapy (IORT), and to identify risk factors associated with complications.

Materials/Methods

We evaluated patients with early-stage breast cancer treated from January 1, 2011 to January 31, 2014 with BCS and IORT at a single institution. The presence of breast cancer recurrences, complications, or fat necrosis were assessed at subsequent follow-up visits using physical examination and breast imaging.

Results

Overall, 113 patients, of whom three were undergoing bilateral treatments, were identified. The median length of time for IORT was 29 min and 36 s (range 15:50–59:00). Fifteen patients received additional external beam radiotherapy (EBRT), and the median follow-up was 40.3 months (range 1.6–58.3) for all patients. To date, one biopsy-proven ipsilateral recurrence has been noted (0.9%), for which the patient elected to undergo a mastectomy. Nine patients were found to have wound complications (7.7%) and two had fat necrosis (1.7%) on follow-up. Of all the evaluated risk factors, only applicator size (p < 0.01) had a statistically significant association with an increase in complications.

Conclusions

With a short follow-up, IORT appears to be a safe treatment modality for a select group of patients, leading to a reasonable increase in operating room time and complication rates following BCS. The utilization of larger applicators at the time of IORT was associated with an increase in wound complications and fat necrosis.
Literatur
1.
Zurück zum Zitat Helvie MA, Chang JT, Hendrick RE, Banerjee M. Reduction in late-stage breast cancer incidence in the mammography era. Cancer. 2014;120:2649–56.CrossRefPubMed Helvie MA, Chang JT, Hendrick RE, Banerjee M. Reduction in late-stage breast cancer incidence in the mammography era. Cancer. 2014;120:2649–56.CrossRefPubMed
2.
Zurück zum Zitat Fisher B, Anderson S, Bryant J, et al. Twenty year follow up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.CrossRefPubMed Fisher B, Anderson S, Bryant J, et al. Twenty year follow up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.CrossRefPubMed
3.
Zurück zum Zitat Van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000;92:1143–50.CrossRefPubMed Van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000;92:1143–50.CrossRefPubMed
4.
Zurück zum Zitat Sardaro A, Petruzzelli MF, D’Errico MP, Grimaldi L, Pili G, Portaluri M. Radiation-induced cardiac damage in early left breast cancer patients: risk factors, biological mechansims, radiobiology, and dosimetric constraints. Radiother Oncol. 2012:102;133–142.CrossRef Sardaro A, Petruzzelli MF, D’Errico MP, Grimaldi L, Pili G, Portaluri M. Radiation-induced cardiac damage in early left breast cancer patients: risk factors, biological mechansims, radiobiology, and dosimetric constraints. Radiother Oncol. 2012:102;133–142.CrossRef
5.
Zurück zum Zitat Hopwood P, Haviland JS, Sumo G, Mills J, Bliss JM, Yarnold JR. Comparison of patient-reported breast, arm, and shoulder symptoms and body image after radiotherapy for early breast cancer: 5-year follow-up in the randomised standardisation of breast radiotherapy (START) trials. Lancet Oncol. 2010;11:231–40.CrossRefPubMed Hopwood P, Haviland JS, Sumo G, Mills J, Bliss JM, Yarnold JR. Comparison of patient-reported breast, arm, and shoulder symptoms and body image after radiotherapy for early breast cancer: 5-year follow-up in the randomised standardisation of breast radiotherapy (START) trials. Lancet Oncol. 2010;11:231–40.CrossRefPubMed
6.
Zurück zum Zitat Clarke DH, Lê MG, Sarrazin D, et al. Analysis of local-regional relapses in patients with early breast cancers treated by excision and radiotherapy: experience of the Institut Gustave-Roussy. Int J Radiat Oncol Biol Phys. 1985;11:137-45.CrossRefPubMed Clarke DH, Lê MG, Sarrazin D, et al. Analysis of local-regional relapses in patients with early breast cancers treated by excision and radiotherapy: experience of the Institut Gustave-Roussy. Int J Radiat Oncol Biol Phys. 1985;11:137-45.CrossRefPubMed
7.
8.
Zurück zum Zitat Vaidya JS, Joseph DJ, Tobias JS, et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomized, non-inferiority phase 3 trial. Lancet. 2010;376:91–102.CrossRefPubMed Vaidya JS, Joseph DJ, Tobias JS, et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomized, non-inferiority phase 3 trial. Lancet. 2010;376:91–102.CrossRefPubMed
9.
Zurück zum Zitat Valente SA, Tendulkar RD, Cherian S, et al. TARGIT-R (Retrospective): North American experience with intraoperative radiation using low-kilovoltage X-rays for breast cancer. Ann Surg Oncol. 2016;23(9):2809–15.CrossRefPubMed Valente SA, Tendulkar RD, Cherian S, et al. TARGIT-R (Retrospective): North American experience with intraoperative radiation using low-kilovoltage X-rays for breast cancer. Ann Surg Oncol. 2016;23(9):2809–15.CrossRefPubMed
10.
Zurück zum Zitat Abbott AM, Dossett LA, Loftus L, et al. Intraoperative radiotherapy for early breast cancer and age: clinical characteristics and outcomes. Am J Surg. 2015;210(4):624–8.CrossRefPubMed Abbott AM, Dossett LA, Loftus L, et al. Intraoperative radiotherapy for early breast cancer and age: clinical characteristics and outcomes. Am J Surg. 2015;210(4):624–8.CrossRefPubMed
11.
Zurück zum Zitat National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology. Breast cancer version 3.2015. 16 Jul 2015. National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology. Breast cancer version 3.2015. 16 Jul 2015.
12.
Zurück zum Zitat Strnad V, Ott OJ, Hildebrandt G, et al. 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomized, phase 3, non-inferiority trial. Lancet. 2016;387(10015):229–38.CrossRefPubMed Strnad V, Ott OJ, Hildebrandt G, et al. 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomized, phase 3, non-inferiority trial. Lancet. 2016;387(10015):229–38.CrossRefPubMed
13.
Zurück zum Zitat Marta GN, Macedo CR, de Andrade Carvalho H, Hanna SA, da Silva JL, Riera R. Accelerated partial irradiation for breast cancer: systemic review and meta-analysis of 8653 women in eight randomized trials. Radiother Oncol. 2015;114:42–49.CrossRefPubMed Marta GN, Macedo CR, de Andrade Carvalho H, Hanna SA, da Silva JL, Riera R. Accelerated partial irradiation for breast cancer: systemic review and meta-analysis of 8653 women in eight randomized trials. Radiother Oncol. 2015;114:42–49.CrossRefPubMed
14.
Zurück zum Zitat Olivotto IA, Whelan TJ, Parpia S, et al. Interim cosmetic and toxicity results from RAPID: a randomized trial of accelerated partial breast irradiation using three-dimensional conformal external beam radiation therapy. J Clin Oncol. 2013;31(32):4038–48.CrossRefPubMed Olivotto IA, Whelan TJ, Parpia S, et al. Interim cosmetic and toxicity results from RAPID: a randomized trial of accelerated partial breast irradiation using three-dimensional conformal external beam radiation therapy. J Clin Oncol. 2013;31(32):4038–48.CrossRefPubMed
Metadaten
Titel
Risk Factors Leading to Complications in Early-Stage Breast Cancer Following Breast-Conserving Surgery and Intraoperative Radiotherapy
verfasst von
Sunpreet Rakhra, MD
Kevin Bethke, MD
Jonathan Strauss, MD, MBA
John P. Hayes, MD
Nora Hansen, MD
Seema A. Khan, MD
Irene Helenowski, PhD
Eric D. Donnelly, MD
Publikationsdatum
16.11.2016
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 5/2017
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5679-0

Weitere Artikel der Ausgabe 5/2017

Annals of Surgical Oncology 5/2017 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.