Pseudosclerodermatous Panniculitis After Irradiation: An Unusual Complication of Megavoltage Treatment of Breast Carcinoma

Winkelmann, R. K.; Grado, Gordon L.; Quimby, Steven R.; Connolly, Suzanne M.

doi:10.1016/s0025-6196(12)60158-x

Cited by 47 publications

(37 citation statements)

References 16 publications

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“…In others, the overlying skin looked stretched, shiny and erythematous. Although bacterial cellulitis or cutaneous tumour recurrence could not be excluded on the basis of a photograph alone, the appearances in this minority of patients were entirely consistent with a post-radiation syndrome that presents a few months after radiotherapy with inflammatory symptoms and signs (breast pain and swelling, tenderness and erythema confined within the treatment volume), and resolves over several months [20].…”

Section: Discussionmentioning

confidence: 67%

Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long-term results of a randomised trial

Yarnold

Ashton²,

Bliss

et al. 2005

Radiotherapy and Oncology

460

306

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Background and purpose: Unlike squamous carcinomas, breast adenocarcinoma may be as sensitive to fraction size as late dose-limiting normal tissues. If so, fewer larger fractions would be as safe and effective as regimens based on 2.0 Gy fractions. The first step is to test the effects of radiotherapy fractions O2.0 Gy on late normal tissue responses in the breast after tumour excision and radiotherapy for early breast cancer.Patients and methods: One thousand four-hundred and ten women with T1-3 N0-1 M0 invasive breast cancer were randomised between 1986-98 into one of three radiotherapy regimens after local tumour excision of early stage breast cancer; 50 Gy in 25 fractions (F) vs two dose levels of a test schedule giving 39 or 42.9 Gy in 13 F over 5 weeks. Fraction sizes were 2.0, 3.0 and 3.3 Gy, respectively. The primary endpoint was late change in breast appearance compared to post-surgical appearance scored from annual photographs blinded to treatment allocation. Secondary endpoints included palpable breast induration (fibrosis) and ipsilateral tumour recurrence.Results: After a minimum 5-year follow up, the risk of scoring any change in breast appearance after 50 Gy/25 F, 39 Gy/13 F and 42.9 Gy/13 F was 39.6, 30.3 and 45.7%, from which an a/b value of 3.6 Gy (95% CI 1.8-5.4) is estimated. The a/b value for palpable breast induration was 3.1 Gy (95% CI 1.8-4.4).Conclusions: An a/b value of around 3 Gy for late normal tissue changes in the breast is derived from the estimated equivalence of 41.6 Gy in 13 fractions and 50 Gy in 25 fractions over 5 weeks, in line with trial predictions. q 2005 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 75 (2005) 9-17.

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Section: Discussionmentioning

confidence: 67%

Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long-term results of a randomised trial

Yarnold

Ashton²,

Bliss

et al. 2005

Radiotherapy and Oncology

460

306

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“…The first description by Winkelmann of 4 cases in 1993 was followed by additional 4 cases in 2001. 19,20 These cases were characterized by erythematous indurated plaques in the field of radiation. Biopsies of the affected areas revealed significant changes in the subcutaneous tissues revealing a lobular panniculitis, thickened septae, and an inflammatory infiltrate.…”

Section: Resultsmentioning

confidence: 99%

Post-Irradiation Morphea: Case report and review of the literature

Alhathlool

Hein²,

Andrés³

et al. 2012

J Dermatol Case Rep

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Background/Purpose: Post-irradiation morphea (PIM) is an entity documented in the literature although still not mentioned in most of the dermatological textbooks with a frequency approximately 2 out of every 1000 patients who received radiotherapy. Most of the cases are misdiagnosed as recurrent or metastatic carcinoma. Main observations:We report on a 64-year-old woman who was treated with radiotherapy for breast cancer. Two years and eight months after the first dose of radiotherapy, she developed localized morphea in the irradiated area. Conclusion:We report on a new case with a literature review and discuss pathogenesis, treatment modalities and post irradiation subcutaneos reactions mimicking PIM. Around 54 cases of post-irradiation morphea (PIM) were identified in the literature. (J Dermatol Case Rep. 2012; 6(3): 73-77)

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“…A review of the literature finds 21 previously reported cases of postirradiation morphea of the breast [4, 5, 6, 7, 8, 9, 10], summarized in table 1. In addition, one report describes a case of morphea developing after radiotherapy to the pelvis for endocervical carcinoma [9], and one describes morphea after radiotherapy to the chest wall for subcutaneous lymphoma in an HIV-1-positive patient [10].…”

Section: Discussionmentioning

confidence: 99%

“…However, the increased use of radiation therapy over the last three decades as a common modality in the treatment and palliation of breast cancer has led to the observation of postirradiation morphea of the breast developing months to years after treatment [4, 5, 6, 7, 8, 9, 10]. Morphea, or localized scleroderma, is an inflammatory disorder characterized clinically by thickening and induration of the skin, and histologically by excessive dermal and subcutaneous collagen deposition.…”

Section: Introductionmentioning

confidence: 99%

Postirradiation Morphea of the Breast Presentation of Two Cases and Review of the Literature

et al. 2000

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The advent of radiation therapy as a common modality in the treatment and palliation of breast cancer has led to the observation of morphea developing months to years after supervoltage radiation therapy, in and around the site of treatment. We report 2 new cases of morphea at the site of previous supervoltage radiation therapy for breast cancer. The time period between irradiation and onset of morphea in our 2 patients were an atypically long 6.5 years and 32 years, the latter being the longest reported such interval. With conservative treatment, the inflammatory component of the lesions resolved over an approximately 1-year period, leaving residual sclerosis. These patients are compared to those previously reported in the medical literature so as to summarize the range of clinical presentation and course. Recognition of postirradiation morphea is important in distinguishing it from infectious cellulitis, recurrent carcinoma, metastatic carcinoma or development of a second primary carcinoma.

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Pseudosclerodermatous Panniculitis After Irradiation: An Unusual Complication of Megavoltage Treatment of Breast Carcinoma

Cited by 47 publications

References 16 publications

Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long-term results of a randomised trial

Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long-term results of a randomised trial

Post-Irradiation Morphea: Case report and review of the literature

Postirradiation Morphea of the Breast Presentation of Two Cases and Review of the Literature

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