Breast Calcification Relative to Radiation Dose Distribution 21 years after Radiation Therapy: A Case Report and an Argument Against Hypofractionation of Breast Patients

Abstract

Dystrophic calcification in breast tissue and the chest wall is a common finding in patients undergoing definitive therapy including radiation treatment for breast cancer. In this report, we correlate significant and symptomatic dystrophic dense calcification as a late treatment effect associated with radiation therapy and correlate dosimetry and radiation dose and daily dose fractionation asymmetry to the development of calcifications.

Symptomatic Calcifications after Mastectomy: A Rare Case Report with a Review of the Literature

“…The relationship between the dose and the presence of calcifications has been studied by Herrick et al The authors suggest that calcifications in their case report are exclusively present in regions that received more than 200 cGy/day. Therefore, they conclude that both a dose–volume effect and an effect from fractionation are important for the formation of calcification [ 17 ]. Lee et al concluded that skin calcifications are possible late complications of radiotherapy, especially in long-term survivors after high radiation doses [ 9 ].…”

“…In our case report, the patient experienced the same clinical symptoms, along with the formation of an abscess and a chronic fistula. On the other hand, most patients with calcifications remain asymptomatic, and Herrick et al demonstrated that calcifications after breast cancer surgery and radiotherapy are common findings [ 17 ]. However, the literature does not provide an answer regarding what triggers clinical manifestation in such a small subgroup of patients.…”