scholarly journals Osteoradionecrosis of the Ribs following Breast Radiotherapy

2015 ◽  
Vol 8 (2) ◽  
pp. 332-338 ◽  
Author(s):  
Luke Nicholls ◽  
Peter Gorayski ◽  
Jennifer Harvey
Keyword(s):  
Chest Wall ◽  
Early Stage ◽  
Rare Complication ◽  
Breast Conserving Surgery ◽  
Radiation Sensitivity ◽  
Gene Profiling ◽  
Variable Response ◽  
Breast Radiotherapy ◽  
Whole Breast Radiotherapy ◽  
Standard Fractionation

Introduction: Osteoradionecrosis (ORN) of the chest wall is a rare complication after whole-breast radiotherapy (RT). Herein, we report a case of ORN involving the underlying ribs following adjuvant whole-breast RT using standard fractionation and conduct a review of the literature. Case Report: A previously well 43-year-old female with right-sided, early-stage, node-negative breast cancer was treated with breast-conserving surgery. She subsequently underwent adjuvant whole-breast RT receiving 50 Gy in 25 fractions over 5 weeks using standard tangential photon fields with 6 MV photons followed by an electron boost of 10 Gy in 5 fractions according to International Commission on Radiation Units (ICRU) requirements. Eleven months after RT, the patient developed right lateral chest wall pain, with magnetic resonance imaging (MRI) demonstrating two fractures involving the underlying right fifth and sixth ribs associated with fatty marrow changes in the second to sixth ribs, thus raising the possibility of ORN. Treatments including hyperbaric oxygen, pentoxifylline and vitamin E were used with symptomatic improvements. There was demonstrable resolution on follow-up MRI at 2.5 years. Conclusion: The incidence of ORN utilising modern RT techniques and standard fractionation is rare. Numerous treatments are available, with variable response rates. Emerging evidence of predictive gene profiling to estimate the risk of radiation sensitivity may assist in individualising preventative strategies to mitigate the risk of ORN.

A national multicenter study on 1072 DCIS patients treated with breast-conserving surgery and whole breast radiotherapy (COBCG-01 study)

2019 ◽  
Vol 131 ◽  
pp. 208-214 ◽  
Author(s):  
Icro Meattini ◽  
Nadia Pasinetti ◽  
Bruno Meduri ◽  
Fiorenza De Rose ◽  
Maria Carmen De Santis ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Breast Conserving Surgery ◽  
Breast Radiotherapy ◽  
Whole Breast Radiotherapy

Radiation-induced lung and heart toxicity in patients with early-stage breast cancer treated with hypofractionated radiotherapy following breast-conservative surgery.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 73-73 ◽  
Author(s):  
Ioanna Fragkandrea-Nixon
Keyword(s):  
Breast Cancer ◽  
Negative Impact ◽  
Early Stage ◽  
Strong Association ◽  
Univariate Analysis ◽  
Conservative Surgery ◽  
Published Data ◽  
Breast Radiotherapy ◽  
Whole Breast Radiotherapy ◽  
Group B

73 Background: Hypofractionated RT for breast cancer (BC), although reducing cost and time, could have negative impact on normal underlying lung and heart. We studied and compared lung function and the post –RT radiological changes using High–Resolution CT (HRCT) in early BC patients, treated with 3-D conformal whole breast radiotherapy (WBRT) using either conventional or hypofractionated regime. Additionaly, in patients with right-sided breast cancer, we monitored changes in LVEF performing MUGA scans. Methods: Between 2008 and 2009, 61 early BC patients (TI-2N0M0) were randomised into Group A (n=31) and Group B (n=30) receiving standard radiotherapy with 50Gy/25f/5w plus boost 10Gy/5f/1w to tumour bed or 43.2Gy/16f/22d plus same boost dose respectively. All patients were subjected to dynamic lung testing, on D0 (before RT), during and after RT at 3 and 6 months. HRCT scans were performed at baseline, and 3, 6, 12 months after RT. Dosimetric factors (CLD, V20, D25, MLD) were calculated. MUGA was performed in patients with right sided BC prior and 6 and 12 months post RT. Results: At 3 months after RT, pulmonary changes were classified at HRCT as follows: 91.8% were Grade 0, 8.19% Grade 1, and 0% Grade 2. At 6 months, 86.98% were Grade 0, 11.47 % Grade 1, and 1.6% Grade 2. At 12 months, 88.52% were Grade 0, 9.19 % Grade 1 and 3.27% Grade 2. Univariate analysis showed strong association between radiation pneumonitis, age and all dosimetric parameters. There was no association between fractionation type and incidence of RN. FEV1, FVC, FEV 25, FEV 50 and DLCO showed no statistically significant reduction in both treatment groups in 3 and 6 months following RT, compared to baseline. Multivariate analysis showed no relation between HRCT findings and age, smoking, chemotherapy, hormonotherapy, V20. No changes were found in LVEF prior and 6 and 12 months post radiotherapy. Conclusions: Lung toxicity as assessed with HRCT and PFTs was minimal in both treatment arms and our results are in consistency with other published data. In our series, no significant changes were found in LVEF in both treatment arms.

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