Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Long-term complications associated with breast-conservation surgery and radiotherapy

Abstract

Background

Breast-conservation surgery plus radiotherapy has become the standard of care for early-stage breast cancer; we evaluated its long-term complications.

Methods

We selected patients treated with surgery and radiotherapy between January 1990 and December 1992 (an era in which standard radiation dosages were used) with follow-up for at least 1 year. Patients were prospectively monitored for treatment-related complications. Median follow-up time was 89 months.

Results

A total of 294 patients met the selection criteria. Grade 2 or higher late complications were identified in 29 patients and included arm edema in 13 patients, breast skin fibrosis in 12, decreased range of motion in 4, pneumonitis in 2, neuropathy in 2, fat necrosis in 1, and rib fracture in 1. Arm edema was more common after lumpectomy plus axillary node dissection than after lumpectomy alone. Arm edema occurred in 18% of patients who underwent surgery plus irradiation of the lymph nodes and 10% who underwent surgery without nodal irradiation.

Conclusions

Breast-conservation surgery plus radiotherapy was associated with grade 2 or higher complications in only 9.9% of patients. Half of these complications were attributable to axillary dissection, it is hoped that lower complication rates can be achieved with sentinel lymph node biopsy.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Amalrie R, Santamaria F, Robert F, et al. Radiation therapy with or without primary limited surgery for operable breast cancer: a 20-year experience at the Marseilles Cancer Institute.Cancer 1982;49:30–4.

  2. 2.

    Montague ED, Ames FC, Schell SR, et al. Conservative surgery and irradiation as an alternative to mastectomy in the treatment of clinically favorable breast cancer.Cancer 1984;4:2668–72.

  3. 3.

    Veronesi U, Zucali R, Luini A. Local control and survival in early breast cancer: the Milan trial.Int J Radiat Oncol Biol. Phys 1986; 12:717–20.

  4. 4.

    Sarrazin D, Le M, Rouesse J, et al. Conservative treatment versus mastectomy in breast cancer tumors with macroscopic diameter of 20 millimeters or less. The experience of the Institut Gustave-Roussy.Cancer 1984;53:1209–13.

  5. 5.

    Fisher B, Bauer M, Margolese R, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with and without radiation in the treatment of breast cancer.N Engl J Med 1985;312:665–73.

  6. 6.

    Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer.N Engl J Med 1995;333:1456–61.

  7. 7.

    Zissiadis Y, Langlands AO, Barraclough B, Boyages J. Breast conservation: long-term results from Westmead Hospital.Aust N Z J Surg 1997;67:313–9.

  8. 8.

    Mills JM, Schultz DJ, Solin LJ. Preservation of cosmesis with low complication risk after conservative surgery and radiotherapy for ductal carcinoma in situ of the breast.Int J Radiat Oncol Biol Phys 1997;39:637–41.

  9. 9.

    Clarke D, Martinez A, Coz RS. Analysis of cosmetic results and complications in patients with stage I and II breast cancer treated by biopsy and irradiation.Int J Radiat Oncol Biol Phys 1983;9: 1807–13.

  10. 10.

    Wazer DE, DiPetrillo T, Schmidt-Ullrich R, et al. Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma.J Clin Oncol 1992;10:356–63.

  11. 11.

    Markiewicz DA, Schultz D, Haas JA, et al. The effects of sequence and type of chemotherapy and radiation therapy on cosmesis and complications after breast conservation therapy.Int J Radiat Oncol Biol Phys 1996;15:661–8.

  12. 12.

    Kurtz JM, Miralbell R. Radiation therapy and breast conservation: cosmetic results and complications.Semin Radiat Oncol 1992;2: 125–31.

  13. 13.

    Wei JP, Sherry RM, Baisden BL, et al. Prospective hospital-based survey of attitudes of Southern women toward surgical treatment of breast cancer.Ann Surg Oncol 1995;2:360–4.

  14. 14.

    Stotter AT, McNeese MD, Ames FC, et al. Predicting the rate and extent of locoregional failure after breast conservation therapy for early breast cancer.Cancer 1989;64:2217–25.

  15. 15.

    Borger JH, Kemperman H, Smitt HS, et al. Dose and volume effects on fibrosis after breast conservation therapy.Int J Radiat Oncol Biol Phys 1994;30:1073–81.

  16. 16.

    Roses DF, Brooks AD, Harris MN, et al. Complications of level I and II axillary dissection in the treatment of carcinoma of the breas.Ann Surg 1999;230:194–201.

  17. 17.

    Lin PP, Allison DC, Wainstock J, et al. Impact of axillary lymph node dissection on the therapy of breast cancer patients.J Clin Oncol 1993;11:1536–44.

  18. 18.

    Ivens D, Hoe AL, Podd TJ, et al. Assessment of morbidity from complete axillary dissection.Br J Cancer 1992;66:136–8.

  19. 19.

    Hladiuk M, Huchcroft S, Temple W, Schnurr BE. Arm function after axillary dissection for breast cancer: a pilot study to provide parameter estimates.J Surg Oncol 1992;50:47–52.

  20. 20.

    Keramopoulos A, Tsionou C, Minaretzis D, et al. Arm morbidity following treatment of breast cancer with total axillary dissection: a multivariate approach.Oncology 1993;50:445–9.

  21. 21.

    Kissin MW, della Rovere QG, Easton D, Westbury G. Risk of lymphedema following the treatment of breast cancer.Br J Surg 1986;73:580–4.

  22. 22.

    Gallagher PG, Algird JR. Post radical mastectomy edema of the arm: the role of phlebitis.Angiology 1966;17:377–88.

  23. 23.

    Delouche G, Bachelot F, Premont M, Kurtz JM. Conservation treatment of early breast cancer: long term results and complications.Int J Radiat Oncol Biol Phys 1987;13:29–34.

  24. 24.

    Larson D, Weinstein M, Goldberg I, et al. Edema of the arm as a function of the extent of axillary surgery in patients with stage I–II carcinoma of the breast treated with primary radiotherapy.Int J Radiat Oncol Biol Phys 1986;12:1575–82.

  25. 25.

    Rose CM, Botnick LE, Weinstein M, et al. Axillary sampling in the definitive treatment of breast cancer by radiation therapy and lumpectomy.Int J Radiat Oncol Biol Phys 1983;9:339–44.

  26. 26.

    Satrin RS, Dinshaw KA, Shrivastava SK, et al. Therapeutic factors influencing the cosmetic outcome and late complications in the conservative menagement of early breast cancer.Int J Radiat Oncol Biol Phys 1993;27:285–92.

  27. 27.

    Werner RS, McCormick, Petrek J, et al. Arm edema in conservatively managed breast cancer: obesity is a major predictive factor.Radiology 1991;180:177–84.

  28. 28.

    Simon MS, Cody RL. Cellulitis after axillary lymph node dissection for carcinoma of the breast.Am J Med 1992;93:543–8.

  29. 29.

    Petrek JA, Senie RT, Peters M, et al. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis.Cancer 2001; 92:1368–77.

  30. 30.

    Runnebaum IB, Nagarajan M, Bowman M, et al. Mutations in p53 as potential marker for human breast cancer.Proc Natl Acad Sci USA 1991;88:10657–61.

  31. 31.

    Harris AL, Nicholson S, Sainsbury R, et al. Epidermal growth factor receptor and other oncogenes as prognostic markers.J Natl Cancer Inst Monogr 1992;11:181–7.

  32. 32.

    Johnson MD, Torri JA, Lippman ME, et al. The role of cathepsin D in the invasiveness of human breast cancer cells.Cancer Res 1993;53:873–7.

  33. 33.

    Dhingra K, Hortobagyi GN. Critical evaluation of prognostic factors.Semin Oncol 1996;23:436–45.

  34. 34.

    Elledge RM, Allred DC. Prognostic and predictive value of p53 and p21 in breast cancer.Breast Cancer Res Treat 1998;52:79–98.

  35. 35.

    Mimori K, Ueo H, Shirasaka C, et al. Up-regulated pyrimidine nucleoside phosphorylase in breast carcinoma correlates with lymph node metastasis.Ann Oncol 1999;10:111–3.

  36. 36.

    Yang X, Hao Y, Ding Z, et al. Differential expression of antiapoptotic gene BAG-1 in human breast normal and cancer cell lines and tissues.Clin Cancer Res 1999;5:1816–22.

  37. 37.

    Giuliano AE, Dale PS, Turner RR, Morton DL, Evans SW, Krasne DL. Improved axillary staging of breast cancer with sentinel lymphadenectomy.Ann Surg 1995;222:394–401.

  38. 38.

    Krag DN, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer: a multicenter validation study.N Engl J Med 1998;339: 941–95.

  39. 39.

    Cody HS III, Hill ADK, Tran KN, et al. Credentialing for breast lymphatic mapping: how many cases are enough?Ann Surg 1999; 229:723–8.

  40. 40.

    Bass SS, Cox CE, Ku NN, et al. The role of sentinel lymph node biopsy in breast cancer.J Am Coll Surg 1999;189:183–94.

Download references

Author information

Correspondence to Kelly K. Hunt MD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Meric, F., Buchholz, T.A., Mirza, N.Q. et al. Long-term complications associated with breast-conservation surgery and radiotherapy. Annals of Surgical Oncology 9, 543–549 (2002). https://doi.org/10.1007/BF02573889

Download citation

Key Words

  • Breast cancer
  • Radiotherapy
  • Complication
  • Morbidity
  • Arm edema