The incidence of fat necrosis in balloon-based breast brachytherapy

Abstract

PurposeTo investigate the incidence of and potential risk factors for fat necrosis in high dose-rate (HDR) balloon-based breast brachytherapy (BBB).Material and methodsFifty-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).ResultsWith 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.ConclusionsIn 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.

A Review of Inflammatory Processes of the Breast with a Focus on Diagnosis in Core Biopsy Samples

“…Fat necrosis is most often seen in traumatized breast tissue, particularly in areas of prior surgery or biopsy. Radiation therapy can also lead to fat necrosis in breast [ 1 - 3 ] and has been seen in up to 50% of patients following balloon-based brachytherapy [ 4 ]. Clinically, fat necrosis can present as a palpable mass with or without skin retraction, or it can be asymptomatic [ 5 ].…”

Evaluation of BEBIG HDR 60 Co system for non-invasive image-guided breast brachytherapy

“…Although dosimetric characteristics of these sources have been evaluated using the TG-43 formalism, their clinical applications have not been fully explored, particularly in the U.S. For example, the AccuBoost technique has been introduced (Advanced Radiation Therapy, LLC, Tyngsboro, MA, USA) [ 19 , 20 , 21 ] for boost or accelerated partial breast irradiation (APBI) treatment modalities [ 22 , 23 ] using non-invasive image-guided breast brachytherapy (NIBB) [ 24 , 25 ] in contrast to other interstitial techniques [ 26 , 27 , 28 , 29 ]. The clinical advances of this treatment technique have been demonstrated by different investigators [ 23 ].…”