Analysis of fat necrosis after adjuvant high-dose-rate interstitial brachytherapy for early stage breast cancer

Adam A. Garsa; Daniel J. Ferraro; Todd DeWees; Julie A. Margenthaler; Michael Naughton; Rebecca Aft; William E. Gillanders; Timothy Eberlein; Melissa A. Matesa; Imran Zoberi

doi:10.1016/j.brachy.2012.04.005

Analysis of fat necrosis after adjuvant high-dose-rate interstitial brachytherapy for early stage breast cancer

Adam A. Garsa, Daniel J. Ferraro, Todd DeWees, Julie A. Margenthaler, Michael Naughton, Rebecca Aft, William E. Gillanders, Timothy Eberlein, Melissa A. Matesa, Imran Zoberi

Quantitative Health Sciences

Research output: Contribution to journal › Article › peer-review

22 Scopus citations

Abstract

Purpose: To report the incidence and potential predictors of fat necrosis in women with early stage breast cancer treated with adjuvant high-dose-rate (HDR) multicatheter interstitial brachytherapy. Methods and Materials: Between 2003 and 2010, 238 treated breasts in 236 women were treated with accelerated partial breast irradiation using HDR interstitial brachytherapy. Selection criteria included patients with Tis-T2 tumors measuring ≤3. cm, without nodal involvement, who underwent breast-conserving surgery. Ninety-nine percent of treatments were to a total dose of 34. Gy. The presence and severity of fat necrosis were prospectively recorded during followup. Cosmesis was qualitatively scored in all patients. Cosmesis was quantitatively measured via the percentage breast retraction assessment in 151 cases. Results: Median followup was 56 months. The crude rate of fat necrosis was 17.6%. The rate of symptomatic fat necrosis was 10.1%. In univariate analysis, acute breast infection and anthracycline-based chemotherapy, number of catheters, volume encompassed by the prescription isodose, volume encompassed by the 150% isodose (V₁₅₀), volume encompassed by the 200% isodose, and integrated reference air kerma were significantly associated with fat necrosis. There was significant collinearity between the brachytherapy-related factors; of these, V₁₅₀ was most predictive. In multivariate analysis, only V₁₅₀ was significantly associated with fat necrosis. At 3 years, patients with fat necrosis were more likely to have a fair or poor cosmetic outcome and a larger percentage breast retraction assessment. Conclusions: Mammary fat necrosis is a common adverse event after breast-conserving surgery and HDR interstitial brachytherapy. Fat necrosis is associated with worse qualitative and quantitative cosmetic outcomes. Minimizing exposure volumes, such as V₁₅₀, may decrease the incidence of fat necrosis and improve cosmesis.

Original language	English (US)
Pages (from-to)	99-106
Number of pages	8
Journal	Brachytherapy
Volume	12
Issue number	2
DOIs	https://doi.org/10.1016/j.brachy.2012.04.005
State	Published - Mar 2013

Keywords

Brachytherapy
Breast cancer
Cosmesis
Fat necrosis
Partial breast

ASJC Scopus subject areas

Oncology
Radiology Nuclear Medicine and imaging

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10.1016/j.brachy.2012.04.005

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@article{cbecbb5cbe524433a7366c259c7c8ebe,

title = "Analysis of fat necrosis after adjuvant high-dose-rate interstitial brachytherapy for early stage breast cancer",

abstract = "Purpose: To report the incidence and potential predictors of fat necrosis in women with early stage breast cancer treated with adjuvant high-dose-rate (HDR) multicatheter interstitial brachytherapy. Methods and Materials: Between 2003 and 2010, 238 treated breasts in 236 women were treated with accelerated partial breast irradiation using HDR interstitial brachytherapy. Selection criteria included patients with Tis-T2 tumors measuring ≤3. cm, without nodal involvement, who underwent breast-conserving surgery. Ninety-nine percent of treatments were to a total dose of 34. Gy. The presence and severity of fat necrosis were prospectively recorded during followup. Cosmesis was qualitatively scored in all patients. Cosmesis was quantitatively measured via the percentage breast retraction assessment in 151 cases. Results: Median followup was 56 months. The crude rate of fat necrosis was 17.6%. The rate of symptomatic fat necrosis was 10.1%. In univariate analysis, acute breast infection and anthracycline-based chemotherapy, number of catheters, volume encompassed by the prescription isodose, volume encompassed by the 150% isodose (V150), volume encompassed by the 200% isodose, and integrated reference air kerma were significantly associated with fat necrosis. There was significant collinearity between the brachytherapy-related factors; of these, V150 was most predictive. In multivariate analysis, only V150 was significantly associated with fat necrosis. At 3 years, patients with fat necrosis were more likely to have a fair or poor cosmetic outcome and a larger percentage breast retraction assessment. Conclusions: Mammary fat necrosis is a common adverse event after breast-conserving surgery and HDR interstitial brachytherapy. Fat necrosis is associated with worse qualitative and quantitative cosmetic outcomes. Minimizing exposure volumes, such as V150, may decrease the incidence of fat necrosis and improve cosmesis.",

keywords = "Brachytherapy, Breast cancer, Cosmesis, Fat necrosis, Partial breast",

author = "Garsa, {Adam A.} and Ferraro, {Daniel J.} and Todd DeWees and Margenthaler, {Julie A.} and Michael Naughton and Rebecca Aft and Gillanders, {William E.} and Timothy Eberlein and Matesa, {Melissa A.} and Imran Zoberi",

note = "Funding Information: We thank Alvin J. Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, MO, for the use of the Clinical Trials Core, which provided regulatory services. The Siteman Cancer Center is supported in part by NCI Cancer Center Support Grant ( P30 CA91842 ).",

year = "2013",

month = mar,

doi = "10.1016/j.brachy.2012.04.005",

language = "English (US)",

volume = "12",

pages = "99--106",

journal = "Brachytherapy",

issn = "1538-4721",

publisher = "Elsevier Inc.",

number = "2",

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TY - JOUR

T1 - Analysis of fat necrosis after adjuvant high-dose-rate interstitial brachytherapy for early stage breast cancer

AU - Garsa, Adam A.

AU - Ferraro, Daniel J.

AU - DeWees, Todd

AU - Margenthaler, Julie A.

AU - Naughton, Michael

AU - Aft, Rebecca

AU - Gillanders, William E.

AU - Eberlein, Timothy

AU - Matesa, Melissa A.

AU - Zoberi, Imran

N1 - Funding Information: We thank Alvin J. Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, MO, for the use of the Clinical Trials Core, which provided regulatory services. The Siteman Cancer Center is supported in part by NCI Cancer Center Support Grant ( P30 CA91842 ).

PY - 2013/3

Y1 - 2013/3

N2 - Purpose: To report the incidence and potential predictors of fat necrosis in women with early stage breast cancer treated with adjuvant high-dose-rate (HDR) multicatheter interstitial brachytherapy. Methods and Materials: Between 2003 and 2010, 238 treated breasts in 236 women were treated with accelerated partial breast irradiation using HDR interstitial brachytherapy. Selection criteria included patients with Tis-T2 tumors measuring ≤3. cm, without nodal involvement, who underwent breast-conserving surgery. Ninety-nine percent of treatments were to a total dose of 34. Gy. The presence and severity of fat necrosis were prospectively recorded during followup. Cosmesis was qualitatively scored in all patients. Cosmesis was quantitatively measured via the percentage breast retraction assessment in 151 cases. Results: Median followup was 56 months. The crude rate of fat necrosis was 17.6%. The rate of symptomatic fat necrosis was 10.1%. In univariate analysis, acute breast infection and anthracycline-based chemotherapy, number of catheters, volume encompassed by the prescription isodose, volume encompassed by the 150% isodose (V150), volume encompassed by the 200% isodose, and integrated reference air kerma were significantly associated with fat necrosis. There was significant collinearity between the brachytherapy-related factors; of these, V150 was most predictive. In multivariate analysis, only V150 was significantly associated with fat necrosis. At 3 years, patients with fat necrosis were more likely to have a fair or poor cosmetic outcome and a larger percentage breast retraction assessment. Conclusions: Mammary fat necrosis is a common adverse event after breast-conserving surgery and HDR interstitial brachytherapy. Fat necrosis is associated with worse qualitative and quantitative cosmetic outcomes. Minimizing exposure volumes, such as V150, may decrease the incidence of fat necrosis and improve cosmesis.

AB - Purpose: To report the incidence and potential predictors of fat necrosis in women with early stage breast cancer treated with adjuvant high-dose-rate (HDR) multicatheter interstitial brachytherapy. Methods and Materials: Between 2003 and 2010, 238 treated breasts in 236 women were treated with accelerated partial breast irradiation using HDR interstitial brachytherapy. Selection criteria included patients with Tis-T2 tumors measuring ≤3. cm, without nodal involvement, who underwent breast-conserving surgery. Ninety-nine percent of treatments were to a total dose of 34. Gy. The presence and severity of fat necrosis were prospectively recorded during followup. Cosmesis was qualitatively scored in all patients. Cosmesis was quantitatively measured via the percentage breast retraction assessment in 151 cases. Results: Median followup was 56 months. The crude rate of fat necrosis was 17.6%. The rate of symptomatic fat necrosis was 10.1%. In univariate analysis, acute breast infection and anthracycline-based chemotherapy, number of catheters, volume encompassed by the prescription isodose, volume encompassed by the 150% isodose (V150), volume encompassed by the 200% isodose, and integrated reference air kerma were significantly associated with fat necrosis. There was significant collinearity between the brachytherapy-related factors; of these, V150 was most predictive. In multivariate analysis, only V150 was significantly associated with fat necrosis. At 3 years, patients with fat necrosis were more likely to have a fair or poor cosmetic outcome and a larger percentage breast retraction assessment. Conclusions: Mammary fat necrosis is a common adverse event after breast-conserving surgery and HDR interstitial brachytherapy. Fat necrosis is associated with worse qualitative and quantitative cosmetic outcomes. Minimizing exposure volumes, such as V150, may decrease the incidence of fat necrosis and improve cosmesis.

KW - Brachytherapy

KW - Breast cancer

KW - Cosmesis

KW - Fat necrosis

KW - Partial breast

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Analysis of fat necrosis after adjuvant high-dose-rate interstitial brachytherapy for early stage breast cancer

Abstract

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ASJC Scopus subject areas

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