The incidence of fat necrosis in balloon-based breast brachytherapy

Nitesh N. Paryani, Laura Vallow, Wilza Magalhaes, Michael G. Heckman, Siyong Kim, Ashley Smith, Nancy N. Diehl, Sarah McLaughlin

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: To investigate the incidence of and potential risk factors for fat necrosis in high dose-rate (HDR) balloon- based breast brachytherapy (BBB). Material and methods: Fifty-four patients were treated postoperatively with HDR-BBB between May 2007 and December 2010. Median age was 71 years (range: 50-88 years). Median tumor size was 1 cm (range: 0.1-2.7 cm). Forty-four had invasive histology; 43% were grade 1, 24% grade 2, and 15% grade 3. The median margin size was 0.7 cm (range: 0.1-1.5 cm). Results: With a median follow-up of 2.9 years (range: 0.5-5.2 years), local control was 98% with one in-breast failure, and overall survival was 89%. Fifty percent of patients experienced fat necrosis. Seven patients were symptomatic, with the remainder detected by mammography alone. Two patients required surgical resection with pathology confirming fat necrosis; 1 required i.v. steroids. At 1, 3, and 5 years following treatment, estimated cumulative incidences of fat necrosis were 7.5%, 52.7%, and 60.6%. Breast laterality, location, tumor size, histology, margin size, balloon volume, skin distance, skin dose, and number of dwell positions were not significantly associated with fat necrosis on univariate analysis. Conclusions: In this retrospective review of HDR-BBB, we found a 50% incidence of both asymptomatic and symptomatic fat necrosis. Only three patients, however, required intervention. None of the risk factors considered were significantly associated with fat necrosis. Further studies evaluating factors associated with fat necrosis for patients undergoing HDR-BBB are necessary to appropriately assess the risks associated with treatment.

Original languageEnglish (US)
Pages (from-to)29-34
Number of pages6
JournalJournal of Contemporary Brachytherapy
Volume7
Issue number1
DOIs
StatePublished - 2015

Fingerprint

Fat Necrosis
Brachytherapy
Breast
Incidence
Histology
Skin
Mammography
Neoplasms
Steroids
Pathology
Survival

Keywords

  • Brachytherapy
  • Breast cancer
  • High-dose rate
  • Necrosis
  • Survival toxicity

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Paryani, N. N., Vallow, L., Magalhaes, W., Heckman, M. G., Kim, S., Smith, A., ... McLaughlin, S. (2015). The incidence of fat necrosis in balloon-based breast brachytherapy. Journal of Contemporary Brachytherapy, 7(1), 29-34. https://doi.org/10.5114/jcb.2015.49443

The incidence of fat necrosis in balloon-based breast brachytherapy. / Paryani, Nitesh N.; Vallow, Laura; Magalhaes, Wilza; Heckman, Michael G.; Kim, Siyong; Smith, Ashley; Diehl, Nancy N.; McLaughlin, Sarah.

In: Journal of Contemporary Brachytherapy, Vol. 7, No. 1, 2015, p. 29-34.

Research output: Contribution to journalArticle

Paryani, NN, Vallow, L, Magalhaes, W, Heckman, MG, Kim, S, Smith, A, Diehl, NN & McLaughlin, S 2015, 'The incidence of fat necrosis in balloon-based breast brachytherapy', Journal of Contemporary Brachytherapy, vol. 7, no. 1, pp. 29-34. https://doi.org/10.5114/jcb.2015.49443
Paryani, Nitesh N. ; Vallow, Laura ; Magalhaes, Wilza ; Heckman, Michael G. ; Kim, Siyong ; Smith, Ashley ; Diehl, Nancy N. ; McLaughlin, Sarah. / The incidence of fat necrosis in balloon-based breast brachytherapy. In: Journal of Contemporary Brachytherapy. 2015 ; Vol. 7, No. 1. pp. 29-34.
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abstract = "Purpose: To investigate the incidence of and potential risk factors for fat necrosis in high dose-rate (HDR) balloon- based breast brachytherapy (BBB). Material and methods: Fifty-four patients were treated postoperatively with HDR-BBB between May 2007 and December 2010. Median age was 71 years (range: 50-88 years). Median tumor size was 1 cm (range: 0.1-2.7 cm). Forty-four had invasive histology; 43{\%} were grade 1, 24{\%} grade 2, and 15{\%} grade 3. The median margin size was 0.7 cm (range: 0.1-1.5 cm). Results: With a median follow-up of 2.9 years (range: 0.5-5.2 years), local control was 98{\%} with one in-breast failure, and overall survival was 89{\%}. Fifty percent of patients experienced fat necrosis. Seven patients were symptomatic, with the remainder detected by mammography alone. Two patients required surgical resection with pathology confirming fat necrosis; 1 required i.v. steroids. At 1, 3, and 5 years following treatment, estimated cumulative incidences of fat necrosis were 7.5{\%}, 52.7{\%}, and 60.6{\%}. Breast laterality, location, tumor size, histology, margin size, balloon volume, skin distance, skin dose, and number of dwell positions were not significantly associated with fat necrosis on univariate analysis. Conclusions: In this retrospective review of HDR-BBB, we found a 50{\%} incidence of both asymptomatic and symptomatic fat necrosis. Only three patients, however, required intervention. None of the risk factors considered were significantly associated with fat necrosis. Further studies evaluating factors associated with fat necrosis for patients undergoing HDR-BBB are necessary to appropriately assess the risks associated with treatment.",
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N2 - Purpose: To investigate the incidence of and potential risk factors for fat necrosis in high dose-rate (HDR) balloon- based breast brachytherapy (BBB). Material and methods: Fifty-four patients were treated postoperatively with HDR-BBB between May 2007 and December 2010. Median age was 71 years (range: 50-88 years). Median tumor size was 1 cm (range: 0.1-2.7 cm). Forty-four had invasive histology; 43% were grade 1, 24% grade 2, and 15% grade 3. The median margin size was 0.7 cm (range: 0.1-1.5 cm). Results: With a median follow-up of 2.9 years (range: 0.5-5.2 years), local control was 98% with one in-breast failure, and overall survival was 89%. Fifty percent of patients experienced fat necrosis. Seven patients were symptomatic, with the remainder detected by mammography alone. Two patients required surgical resection with pathology confirming fat necrosis; 1 required i.v. steroids. At 1, 3, and 5 years following treatment, estimated cumulative incidences of fat necrosis were 7.5%, 52.7%, and 60.6%. Breast laterality, location, tumor size, histology, margin size, balloon volume, skin distance, skin dose, and number of dwell positions were not significantly associated with fat necrosis on univariate analysis. Conclusions: In this retrospective review of HDR-BBB, we found a 50% incidence of both asymptomatic and symptomatic fat necrosis. Only three patients, however, required intervention. None of the risk factors considered were significantly associated with fat necrosis. Further studies evaluating factors associated with fat necrosis for patients undergoing HDR-BBB are necessary to appropriately assess the risks associated with treatment.

AB - Purpose: To investigate the incidence of and potential risk factors for fat necrosis in high dose-rate (HDR) balloon- based breast brachytherapy (BBB). Material and methods: Fifty-four patients were treated postoperatively with HDR-BBB between May 2007 and December 2010. Median age was 71 years (range: 50-88 years). Median tumor size was 1 cm (range: 0.1-2.7 cm). Forty-four had invasive histology; 43% were grade 1, 24% grade 2, and 15% grade 3. The median margin size was 0.7 cm (range: 0.1-1.5 cm). Results: With a median follow-up of 2.9 years (range: 0.5-5.2 years), local control was 98% with one in-breast failure, and overall survival was 89%. Fifty percent of patients experienced fat necrosis. Seven patients were symptomatic, with the remainder detected by mammography alone. Two patients required surgical resection with pathology confirming fat necrosis; 1 required i.v. steroids. At 1, 3, and 5 years following treatment, estimated cumulative incidences of fat necrosis were 7.5%, 52.7%, and 60.6%. Breast laterality, location, tumor size, histology, margin size, balloon volume, skin distance, skin dose, and number of dwell positions were not significantly associated with fat necrosis on univariate analysis. Conclusions: In this retrospective review of HDR-BBB, we found a 50% incidence of both asymptomatic and symptomatic fat necrosis. Only three patients, however, required intervention. None of the risk factors considered were significantly associated with fat necrosis. Further studies evaluating factors associated with fat necrosis for patients undergoing HDR-BBB are necessary to appropriately assess the risks associated with treatment.

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