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Cellulitis of the Breast as a Complication of Breast-Conserving Surgery and Irradiation

Hughes, Lorie L., M.D.; Styblo, Toncred M., M.D.; Thoms, William W., M.D.; Schwarzmann, Stephen W., M.D.; Landry, Jerome C., M.D.; Heaton, Diane, M.D.; Carlson, Grant W., M.D.; Wood, William C., M.D.

American Journal of Clinical Oncology: August 1997 - Volume 20 - Issue 4 - p 338-341

Breast-conserving therapy (BCT) has become a standard treatment option for patients with early-stage breast cancer. We have observed cellulitis of the treated breast as a complication occurring before, during, and after breast irradiation. The cases of five women (median follow-up, 28 months; range, 24-65 months) who developed cellulitis before (n = 1), during (n = 2), or after (n = 2) breast irradiation were reviewed. A consecutive series of BCT patients at Emory University was reviewed to determine the incidence of this complication. Four of five women had an axillary dissection, yielding a median of 14 negative lymph nodes (range, 6-22 nodes). Two of four patients developed axillary seromas requiring aspiration. In these four patients, only the breast was irradiated. A fifth patient had no axillary dissection and had breast and supraclavicular/axillary irradiation. The median whole breast dose was 50 Gy (range, 46-50.4 Gy). The clinical features of cellulitis included erythema, edema, tenderness, and warmth in all patients. Cellulitis was a relapsing problem for four of the five patients. The incidence of this complication in our series of BCT patients was ∼ 1%. Cellulitis in the ipsilateral breast can be a relapsing complication of BCT and can be seen before, during, or after breast irradiation. Axillary seromas and aspiration seem to indicate a subset of patients at risk of early cellulitis. Late cellulitis may be caused by a variety of factors related to modifications of vascular and skin integrity by surgery and radiotherapy. Prompt diagnosis and appropriate antibiotic therapy is recommended. This problem need not interrupt a course of breast irradiation, and does not necessarily lead to a poor cosmetic result.

From the Departments of Radiation Oncology (L.L.H., W.W.T., J.C.L.), Surgery (T.M.S., G.W.C., W.C.W.), and Medicine (S.W.S.), Emory University School of Medicine, Atlanta, Georgia, and the Department of Radiation Oncology (D.H.), University of Tennessee School of Medicine, Memphis, Tennessee, U.S.A.

Address correspondence and reprint requests to Dr. Lorie L. Hughes, The Emory Clinic, Department of Radiation Oncology, 1365 Clifton Road, Atlanta, GA 30322, U.S.A.

© Lippincott-Raven Publishers.