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Post IORT seroma complication in breast cancer surgery

Published online by Cambridge University Press:  11 September 2020

Maha Abdel Hadi Open the ORCID record for Maha Abdel Hadi [Opens in a new window] ,
Afnan Al-Muhanna ,
Lina Abu Arida  and
Dina Lutfi
Maha Abdel Hadi*
Affiliation:
Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Afnan Al-Muhanna
Affiliation:
Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Lina Abu Arida
Affiliation:
Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Dina Lutfi
Affiliation:
Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
*
Author for correspondence: Maha Abdel Hadi, Breast Division, Department of Surgery, Imam Abdulrahman Bin Faisal University, P.O. Box 40293, Alkhobar31952, Dammam, Saudi Arabia. E-mail: [email protected]\[email protected]
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Abstract

Background:

Intraoperative radiotherapy (IORT) has gained popularity over recent years due to its impact on shortening the radiotherapy treatment time for early breast cancer. It has certainly proven effective as an exclusive treatment or when combined with whole breast irradiation (WBIR). Seroma is a common non-life-threatening complication that may delay treatment and impose challenges on radiological diagnostic follow-up.

Aim:

To review and compare the occurrence of seroma in patients who received exclusive IORT or when combined with WBIR and to outline the diagnostic challenges encountered during radiological follow-up.

Materials and methods:

Based on strict selection criteria, all eligible patients who received IORT ± WBIR treatment between 2012 and 2019 in a university hospital setting were included. Demographic data, histological diagnosis, tumour size, tumour grade, lymphovascular invasion, nodal status, receptor status, treatment with neoadjuvant hormonal chemotherapy, applicator size, dose used, duration of radiotherapy treatment, timing of seroma development and duration of seroma were documented. Both clinical and radiological follow-up were exercised in all patients.

Results:

The total number of patients treated with breast conserving surgery (BCS) and IORT was 86. Age ranged between 31 and 75 years with the median age of 51 years. Patients treated exclusively with IORT were 39 (45%) while those who received the IORT as a boost were 47 (55%). Seroma was observed in 39(45%) of both IORT and IORT\WBIR patients. Those included 15(38%) of the exclusive IORT treated patients and 24 (62%) of those treated as a boost. Duration of asymptomatic seroma ranged from 6 months to 6 years. Repeated aspiration was performed in 2 (5%) patients. Postoperative seroma occurred independent of age histological diagnosis, tumour size, tumour grade, lymphovascular invasion, nodal status, receptor status, treatment with neoadjuvant hormonal\chemotherapy, applicator size, dose used or duration of radiotherapy treatment. All reviewed patients have shown increased risk of developing seroma; however, an increased incidence of seroma in the IORT + WBIR treated patients was higher than those who received exclusive IORT treatment.

Conclusion:

Postoperative seroma is a common non-life-threatening entity that occasionally may lead to delay in the subsequent treatment plan. IORT is a safe modality with many benefits; however, it may increase the risk of seroma formation independent of the clinical parameters. Promoting the expertise in post IORT breast imaging aids in overcoming diagnostic challenges.

Keywords

breast cancerintraoperative radiotherapyseromawhole breast irradiation
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 1 , March 2022 , pp. 7 - 13
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Katipamula, R, Degnim, A, Hoskin, T et al. Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol 2009; 27(25): 4082–4088.CrossRefGoogle Scholar
Bertozzi, N, Pesce, M, Santi, PL, Raposio, E. Oncoplastic breast surgery: comprehensive review. Eur Rev Med Pharmacol Sci 2017; 21: 2572–2585.Google ScholarPubMed
Woodworth, PA, McBoyle, MF, Helmer, SD, Beamer, RL. Seroma formation after breast cancer surgery: incidence and predicting factors. Am Surg 2000; 66: 444–450.Google ScholarPubMed
Budd, DC, Cochran, RC, Sturtz, DL, Fouty, WJ. Surgical morbidity after mastectomy operations. Am J Surg 1978; 135: 218–220.CrossRefGoogle ScholarPubMed
Aitkin, DR, Minton, JP. Complications associated with mastectomy. Surg Clin North Am 1983; 63: 1331–1352.CrossRefGoogle Scholar
Bryant, M, Baum, M. Postoperative seroma following mastectomy and axillary dissection. Br J Surg 1987; 74(12): 1187. doi: 10.1002/bjs.1800741239 CrossRefGoogle ScholarPubMed
Belletti, B, Vaidya, JS, D’Andrea, S et al. Targeted intraoperative radiotherapy impairs the stimulation of breast cancer cell proliferation and invasion caused by surgical wounding. Clin Cancer Res. 2008; 14(5): 1325–1332.CrossRefGoogle ScholarPubMed
Sindelar, WF, Kinsella, TJ. Normal tissue tolerance to intraoperative radiotherapy. Surg Oncol Clin N Am 2003; 12(4): 925–942. doi: 10.1016/s1055-3207(03)00087-5 CrossRefGoogle ScholarPubMed
Ruano-Ravina, A, Cantero-Munoz, P, Eraso Urien, A. Efficacy and safety of intraoperative radiotherapy in breast cancer: a systematic review. Cancer Lett 2011; 313: 15–25.CrossRefGoogle ScholarPubMed
Epstein, M., Silverstein, M., Lin, K. et al. Acute and chronic complications in breast cancer patients treated with intraoperative radiation therapy. Ann Surg Oncol 2016; 23: 3304–3309. https://doi.org/10.1245/s10434–016–5316-y CrossRefGoogle ScholarPubMed
Epstein, M, Silverstein, M, Lin, K et al. Acute and chronic complications in breast cancer patients treated with intraoperative radiation therapy. Ann Surg Oncol 2016; 3304.CrossRefGoogle ScholarPubMed
Matory, WE, Wertheimer, M, Fitzgerald, TJ. Aesthetic results following partial mastectomy and radiation therapy. Plast Reconstr Surg 1990; 85: 739–746.CrossRefGoogle ScholarPubMed
Clough, KB, Cuminet, J, Fitoussi, A, Nos, C, Mosseri, V. Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg 1998; 41: 471–481.CrossRefGoogle Scholar
D’Aniello, C, Grimaldi, L, Barbato, A, Bosi, B, Carli, A. Cosmetic results in 242 patients treated by conservative surgery for breast cancer. Scand J Plast Reconstr Surg Hand Surg 1999; 33: 419–422.Google ScholarPubMed
Urban, C, Lima, R, Schunemann, E, Spautz, C, Rabinovich, I. Oncoplastic principles in breast conserving surgery. Breast 2011; 20: S92–S95.CrossRefGoogle ScholarPubMed
Vernonesi, U, Marubini, E, Mariani, L. Radiotherapy after breast conserving surgery in small breast carcinoma: long-term if a randomized trial. Ann Oncol 2002; 12(9): 997–1003.Google Scholar
Fisher, B, Anderson, S, Bryant, J et al. Twenty-year follow- up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl Med 2002; 347: 1233–1241.CrossRefGoogle ScholarPubMed
Budd, DC, Cochran, RC, Sturtz, DL, Fouty, WJ. Surgical morbidity after mastectomy operations. Am J Surg 1978; 135: 218–220.CrossRefGoogle ScholarPubMed
Aitkin, DR, Minton, JP. Complications associated with mastectomy. Surg Clin North Am 1983; 63: 1331–1352.CrossRefGoogle Scholar
Blank, E, Kraus-Tiefenbacher, U, Welzel, G et al. Single-center long-term follow-up after intraoperative radiotherapy as a boost during breast-conserving surgery using low-kilovoltage x-rays. Ann Surg Oncol 2010; 17(Suppl 3): 352–358.CrossRefGoogle ScholarPubMed
Veronesi, U, Orecchia, R, Luini, A et al. Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery: experience with 590 cases. Ann Surg 2005; 242: 101–106.CrossRefGoogle ScholarPubMed
Blank, E, Kraus-Tiefenbacher, U, Welzel, G et al. Single-center long-term follow-up after intraoperative radiotherapy as a boost during breast-conserving surgery using low-kilovoltage x-rays. Ann Surg Oncol 2010; 17(Suppl 3): 352–358.CrossRefGoogle ScholarPubMed
Ivaldi, GB, Leonardi, MC, Orecchia, R et al. Preliminary results of electron intraoperative therapy boost and hypofractionated external beam radiotherapy after breast-conserving surgery in premenopausal women. Int J Radiat Oncol Biol Phys 2008; 72: 485–493.CrossRefGoogle ScholarPubMed
Ruano-Ravina, A, Cantero-Munoz, P, Eraso Urien, A. Efficacy and safety of intraoperative radiotherapy in breast cancer: a systematic review. Cancer Lett 2011; 313: 15–25. doi: 10.1016/j.canlet.2011.08.020 CrossRefGoogle ScholarPubMed
Tuschy, B, Berlit, S, Romero, S et al. Clinical aspects of intraoperative radiotherapy in early breast cancer: short-term complications after IORT in women treated with low energy x-rays. Radiat Oncol. 2013; 8: 95. Published 2013 Apr 22. doi: 10.1186/1748-717X-8-95 CrossRefGoogle ScholarPubMed
Kraus-Tiefenbacher, U, Scheda, A, Steil, V et al. Intraoperative radiotherapy (IORT) for breast cancer using the Intrabeam system. Tumori 2005, 91: 339–345.CrossRefGoogle ScholarPubMed
Tuschy, B, Berlit, S, Romero, S et al. Clinical aspects of intraoperative radiotherapy in early breast cancer: short-term complications after IORT in women treated with low energy x-rays. Radiat Oncol 2013; 8: 95.CrossRefGoogle ScholarPubMed
Kraus-Tiefenbacher, U, Welzel, G, Brade, J et al. Postoperative seroma formation after intraoperative radiotherapy using low-kilovoltage X-rays given during breast-conserving surgery. Int J Radiat Oncol Biol Phys 2010; 77: 1140–1145.CrossRefGoogle ScholarPubMed
Ruch, M, Brade, J, Schoeber, C et al. Long-term follow-up-findings in mammography and ultrasound after intraoperative radiotherapy (IORT) for breast cancer. Breast 2009; 18: 327–334, http://dx.doi.org/10.1016/j.breast.2009.09.010 CrossRefGoogle ScholarPubMed
Wenz, F, Welzel, G, Keller, A et al. Early initiation of external beam radiotherapy (EBRT) may increase the risk of long-term toxicity in patients undergoing intraoperative radiotherapy (IORT) as a boost for breast cancer. Breast (Edinb, Scotl) 2008; 17: 617–622. http://dx.doi.org/10.1016/j.breast.2008.05.009.26 CrossRefGoogle ScholarPubMed
Wenz, F, Welzel, G, Blank, E et al. Intraoperative radiotherapy as a boost during breast-conserving surgery using low-kilovoltage X-rays: the first 5 years of experience with a novel approach. Int J Radiat Oncol Biol Phys 2010; 77: 1309–1314. http://dx.doi.org/10.1016/j.ijrobp.2009.06.085.36 CrossRefGoogle ScholarPubMed
Senthi, S, Link, E, Chua, BH. Cosmetic outcome and seroma formation after breast-conserving surgery with intraoperative radiation therapy boost for early breast cancer. Int J Radiat Oncol Biol Phys 2012; 84(2): e139–e144.CrossRefGoogle ScholarPubMed
Falco, M, Masojć, B, Rolla, M et al. Risk factors for seroma evacuation in breast cancer patients treated with intraoperative radiotherapy reports of practical oncology and radiotherapy. Rep Pract Oncol Radiother 2016; 21: 225–231.CrossRefGoogle Scholar
Bartelink, H, Horiot, J-C, Poortmans, PM et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC22881–10882 trial. J Clin Oncol 2007; 25: 3259–3265, http://dx.doi.org/10.1200/JCO.2007.11.4991.8 CrossRefGoogle ScholarPubMed
Collette, S, Collette, L, Budiharto, T et al. Predictors of the risk of fibrosis at 10 years after breast conserving therapy for early breast cancer: a study based on the EORTC Trial22881–10882 boost versus no boost. Eur J Cancer 2008; 44: 2587–2599. http://dx.doi.org/10.1016/j.ejca.2008.07.032.9 CrossRefGoogle Scholar
Tuschy, B et al. Clinical aspects of intraoperative radiotherapy in early breast cancer: short-term complications after IORT in women treated with low energy x-rays. Radiat Oncol 2013; 8: 95.CrossRefGoogle ScholarPubMed
Joseph, DJ, Bydder, S, Jackson, LR et al. Saunders CM: prospective trial of intraoperative radiation treatment for breast cancer. ANZ J Surg 2004; 74: 1043–1048. doi: 10.1111/j.1445-1433.2004.03264.x CrossRefGoogle ScholarPubMed
Wenz, F, Sedlmayer, F, Herskind, C et al. Accelerated partial breast irradiation in clinical practice. Breast Care (Basel) 2015; 10(4): 247–252. doi: 10.1159/000437194 CrossRefGoogle ScholarPubMed
Elsberger, B, Romsauerova, A, Vinnicombe, S et al. Comparison of mammographic findings after intraoperative radiotherapy or external beam whole breast radiotherapy. Eur J Surg Oncol 2014; 40(2): 163–167. doi: 10.1016/j.ejso.2013.11.011. Epub 2013 Dec 4.CrossRefGoogle ScholarPubMed
Dershaw, DD. Breast imaging and the conservative treatment of breast cancer. Radiol Clin North Am 2002; 40: 501–516 CrossRefGoogle ScholarPubMed
Goble, RN, Drukteinis, JS, Lee, MC, Khakpour, N, Kiluk, JV, Laronga, C. Early experience with ultrasound features after intrabeam intraoperative radiation for early stage breast cancer. J Surg Oncol. 2014; 109(8): 751–755. doi: 10.1002/jso.23581. Epub 2014 Feb 20CrossRefGoogle ScholarPubMed
Rotaru, N, Punga, J, Crivceanschii, M, Codreanu, I. Organized breast seroma mimicking local tumor recurrence. Breast J 2017; 23(5): 601–602. doi: 10.1111/tbj.12795 CrossRefGoogle ScholarPubMed
Herskind, C, Steil, V, Kraus-Tiefenbacher, U, Wenz, F. Radiobiological aspects of intraoperative radiotherapy (IORT) with isotropic low-energy X rays for early-stage breast cancer. Radiat Res 2005; 163: 208–215.CrossRefGoogle ScholarPubMed
Wasser, K., Schoeber, C., Kraus-Tiefenbacher, U. et al. Early mammographic and sonographic findings after intraoperative radiotherapy (IORT) as a boost in patients with breast cancer. Eur Radiol 2007; 17: 1865.CrossRefGoogle ScholarPubMed
Engel, D, Schnitzer, A, Brade, J et al. Are mammographic changes in the tumor bed more pronounced after intraoperative radiotherapy for breast cancer? Subgroup analysis from a randomized trial (TARGIT-A). Breast J 2013; 19: 92–95.CrossRefGoogle Scholar
Wasser, K, Ruch, M, Brade, J et al. Do structural changes in the tumour bed after intraoperative radiotherapy (IORT) of breast cancer complicate the evaluation of mammograms in a long-term follow-up? Eur J Radiol 2012; 81(3), e255–e259.CrossRefGoogle ScholarPubMed
Wasser, K, Ruch, M, Brade, J et al. Do structural changes in the tumor bed after intraoperative radiotherapy (IORT) of breast cancer complicate the evaluation of mammograms in a long-term follow-up? Eur J Radiol 2012; 81: 255–259.CrossRefGoogle ScholarPubMed
Aurélie Jalaguier-Coudray, M et al. Calcifications and tungsten deposits after breast-conserving surgery and intraoperative radiotherapy for breast cancer. Eur J Radiol 2015; 84: 2521–2525 CrossRefGoogle Scholar