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Late radiation side effects, cosmetic outcomes and pain in breast cancer patients after breast-conserving surgery and three-dimensional conformal radiotherapy

Risk-modifying factors

Spätnebenwirkungen der Bestrahlung, kosmetisches Ergebnis und Schmerzen bei Brustkrebspatientinnen nach brusterhaltender Chirurgie und dreidimensionaler konformaler Strahlentherapie

Risikomodifizierende Faktoren

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Abstract

Background and purpose

The purpose of this work was to identify parameters influencing the risk of late radiation side effects, fair or poor cosmetic outcomes (COs) and pain in breast cancer patients after breast-conserving therapy (BCT) and three-dimensional conformal radiotherapy (3D-CRT).

Patients and methods

Between 2006 and 2013, 159 patients were treated at the Hannover Medical School. Physician-rated toxicity according to the LENT-SOMA criteria, CO and pain were assessed by multivariate analysis.

Results

LENT-SOMA grade 1–4 toxicity was observed as follows: fibrosis 10.7 %, telangiectasia 1.2 %, arm oedema 8.8 % and breast oedema 5.0 %. In addition, 15.1 % of patients reported moderate or severe breast pain, and 21.4 % complained about moderate or severe pain in the arm or shoulder. In multivariate analysis, axillary clearing (AC) was significantly associated with lymphoedema of the arm [odds ratio (OR) 4.37, p = 0.011, 95 % confidence interval (CI) 1.4–13.58]. Breast oedema was also highly associated with AC (OR 10.59, p = 0.004, 95 % CI 2.1–53.36), a ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C (OR 5.34, p = 0.029, 95 % CI 1.2–24.12). A ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C were the parameters significantly associated with an unfavourable CO (OR 3.19, p = 0.019, 95 % CI 1.2–8.4). Concerning chronic breast pain, we found a trend related to the prescribed radiation dose including boost (OR 1.077, p = 0.060, 95 % CI 0.997–1.164). Chronic shoulder or arm pain was statistically significantly associated with lymphoedema of the arm (OR 3.9, p = 0.027, 95 % CI 1.17–13.5).

Conclusion

Chronic arm and breast oedema were significantly influenced by the extent of surgery (AC). Ptotic and large breasts were significantly associated with unfavourable COs and chronic breast oedema. Late toxicities exclusive breast pain were not associated with radiotherapy parameters.

Zusammenfassung

Hintergrund und Ziel

Ziel dieser Arbeit war es, Parameter zu identifizieren, die Spätschäden nach Radiotherapie, ein ungünstiges kosmetisches Ergebnis (CO) und Schmerzen bei Brustkrebspatientinnen nach brusterhaltender Therapie (BCT) und dreidimensionaler konformaler Radiotherapie (3D-CRT) beeinflusst haben.

Patienten und Methoden

Zwischen 2006 und 2013 wurden an der Medizinischen Hochschule Hannover 159 Patientinnen behandelt. Die nach LENT-SOMA-Kriterien bewerteten Spätnebenwirkungen sowie das CO und Schmerzen wurden mittels multivariater Analyse ausgewertet.

Ergebnisse

Folgende Spätnebenwirkungen vom LENT-SOMA Grad 1–4 wurden beobachtet: Strahlenfibrose 10,7 %, Teleangiektasien 1,2 %, Lymphödem des Arms 8,8 % und Brustödem 5,0 %. Mäßigen bis schweren Schmerz in der Brust gaben 15,1 % an, mäßigen bis schweren Schmerz im Arm-Schulter-Bereich 21,4 %. In der multivariaten Analyse zeigte sich ein signifikanter Zusammenhang zwischen Axilladissektion und chronischem Lymphödem des Arms [Odds Ratio (OR) 4,37; p = 0,011; 95 %-Konfidenzintervall (KI) 1,4–13,58] und der Brust (OR 10,59; p = 0,04; 95 %-KI 2,1–53,36). Signifikanz bestand zwischen Ptosis vom Grad 2/3 oder einer Pseudoptosis bei einer Brustgröße ≥ C-Cup und einem chronischem Brustödem (OR 5,34; p = 0,029; 95 %-KI 1,2–24,12) sowie einem ungünstigen CO (OR 3,19; p = 0,019; 95 %-KI 1,2–8,4). Es zeigte sich ein Trend für die Gesamtstrahlendosis inklusive Boost und chronischem Brustschmerz (OR 1,077; p = 0,060; 95 %-KI 0,997–1,164). Chronischer Schulter- und Armschmerz war signifikant assoziiert mit einem chronischen Lymphödem des Arms (OR 3,9; p = 0,027; 95 %-KI 1,17–13,5).

Schlussfolgerung

Chronische Ödeme des Arms und der Brust zeigen eine signifikante Abhängigkeit vom Ausmaß der chirurgischen axillären Intervention. Ptotische und große Mammae hatten signifikant häufiger ein mäßiges CO und ein chronisches Brustödem. Mit Ausnahme vom chronischen Brustschmerz gab es keine Assoziation zwischen Spätnebenwirkungen und Strahlentherapieparametern.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany

    Ursula Hille-Betz M.D., Philipp Soergel M.D.,Ph.D., Sudip Kundu M.D., Rüdiger Klapdor M.D. & Peter Hillemanns M.D., Ph.D.

  2. Institute of Medical Biometry and Informatics, Hannover Medical School, Hannover, Germany

    Bernhard Vaske

  3. Department of Radiation Oncology and Special Oncology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany

    Michael Bremer M.D., Ph.D. & Christoph Henkenberens M.D.

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  1. Ursula Hille-Betz M.D.
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  2. Bernhard Vaske
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Correspondence to Christoph Henkenberens M.D..

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Conflict of interest

U. Hille-Betz, B. Vaske, M. Bremer, P. Soergel, S. Kundu, R. Klapdor, P. Hillemanns, and C. Henkenberens state that there are no conflict of interest.

This restrospective analysis was approved by the local ethics committee. Informed consent was obtained from all patients. Bernhard Vaske from the Institute of Medical Biometry and Informatics of the Hannover Medical School conducted the data management.

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Hille-Betz, U., Vaske, B., Bremer, M. et al. Late radiation side effects, cosmetic outcomes and pain in breast cancer patients after breast-conserving surgery and three-dimensional conformal radiotherapy. Strahlenther Onkol 192, 8–16 (2016). https://doi.org/10.1007/s00066-015-0899-y

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