Radiation Fibrosis Syndrome Imitating Breast Cancer Recurrence; A Case Report

Abstract

Nowadays, surgery, radiotherapy and chemotherapy are the most frequently used modalities in the treatment of breast cancer. It is very well-known that some severe complications may result from after these treatments. Early and late complications of radiotherapy are well known. The complications of radiation therapy may be seen in (early) or after three months (late-delayed) of periods. These complications may be related with direct or indirect effect of radiation. The radiation fibrosis syndrome is a progressive fibrotic tissue sclerosis together with various clinical symptoms in the irradiation field. It is usually a late finding of radiation therapy and may be seen weeks or even years after the treatment. Many systems such as musculo-skeletal, soft tissue, neural tissue and cardiopulmonary system may be affected. In this report, we present a case of a breast cancer treated with breast conserving surgery and radiation therapy twelve years ago. The patient had ipsilateral lymphedema, right axillary mass, and pain during arm and shoulder mobilization. Her physical examination and radiologic findings revealed a big mass invading right thoracic wall, thoracic cavity and the axilla. Histopathological evaluation performed after tru-cut and open biopsy from the mass showed fibrosis resulting from radiation therapy.

Study of the Radiosensitizing and Radioprotective Efficacy of Bromelain (a Pineapple Extract): In Vitro and In Vivo

“…Animal grouping. Animals were randomly divided into 5 groups (10 mice each), Group 1: control not bearing tumor (received PBS i.p for 10 days), Group 2: Ehrlich solid tumor (EST) bearing mice (received PBS i.p for 10 days), Group 3: EST + γ-irradiation (1 Gy × 5) fractionated doses starting 2 days after tumor appearance (10 mm 3 ) and lasting for 5 days, Group 4: EST bearing mice receiving freshly prepared BL dissolved in PBS (6 mg/kg, i.p), daily for 10 days according to pilot study, starting once EST becomes 10 mm 3 . BL was purchased from Merck KGaA Co. (Darmstadt, Germany), Group 5: EST bearing mice received BL (as in group 4) 2 hours before γ-irradiation (as in group 3).…”

“… 1 However, from the clinical perspective, radiotherapy provides inadequate success due to the radioresistance of many tumors as well as the high risk of recurrence, and effects on normal cells may occur. 2 , 3 Radioresistance occurs as the microenvironment of solid tumors is hypoxic compared with normal tissue. 4 In addition, some tumors have either an intrinsic resistance to ionizing radiation or can attain this property through accumulation of genetic mutations causing an increased survival and proliferation.…”

Progressive breast fibrosis caused by extreme radiosensitivity: Oncocytogenetic diagnosis and treatment by reconstructive flap surgery

“…In the case of potential radiation overexposure accidents, the use of chromosomal aberration assay is also advisable after radiotherapy, for example in the case of severe late toxicities. Radiation‐induced fibrosis occurring more than a decade after breast cancer therapy with the suspicion of recurrent breast tumour has been reported in the literature . Therefore, patients with the suspicion of tumour recurrence that has been precluded by biopsy may also benefit because further ionising load (X‐ray, CT scans) can be reduced.…”

Radiation Fibrosis Syndrome: The Evergreen Menace of Radiation Therapy

“…[10] Histopathological analysis may reveal hyalinized fibrotic tissue with spotty hyalinizing necrosis infiltrating the striated muscular, adipose, vascular, and nervous tissues. [58] Immunohistochemistry may be used to differentiate between RIF and other pathologies of the primary tissue. [5]…”

“…[2] Subsequent fibrosis reduces tissue compliance and causes cosmetic and functional impairment that significantly impacts the QOL in the majority of cancer patients, and particularly those with head-and-neck (H and N) cancer. [5]…”