Background: Breast cancer is still the most common indication for chest wall
irradiation, despite the advances in RTH techniques complications still occur,
and the time of its occurrence vary and could take few months to many years.
ORN usually manifests with pain, exposed bone, fistulae and pathological
fracture and the proper management needs proper debridement and coverage by
thick musculocutaneous
flaps. Objective: To evaluate different techniques of surgical
management of post-irradiation
persistent radio-necrotic ulcer & ORN with emphasis on the outcome of each
technique. Patients and methods: A retrospective study from 2010 to 2015 reviewed 20 patients
subjected to post-mastectomy radiotherapy as a treatment for breast cancer inNCICairo, and Minia oncology center Hospital,
Egypt. Cases were biopsied to exclude local recurrence. The age, sex, type of
ulcer, dose of radiotherapy received and the management done for these cases were recorded. Results:
Only 4 patients responded to conservative treatment in the form of repeated
dressings, and 16 patients needed surgical treatment; 5 of them were treated
with debridement and coverage with split thickness graft with high rate of
complications reaching 80%, the other 11 patients were reconstructed with musculocutanoeus flaps, of
these 7 patients were reconstructed with LD flaps with 57.14% success rate and
minor complications only, the other 4 cases were reconstructed with TRAM flap
with 50% success and major loss of the flap in one case that needed salvage by
LD flap. Pre-operative comorbidity w
References
[1]
Overgaard, et al. (1999) Postoperative Radiotherapy in High-Risk Postmenopausal Breast Cancer Patients Given Adjuvant Tamoxifen: Danish Breast Cancer Cooperative Group DBCG82c Randomised Trial. The Lancet, 353, 1641-1648.
https://doi.org/10.1016/S0140-6736(98)09201-0
[2]
Veronesi, U., Salvadori, B., Luini, A., et al. (1995) Breast Conservation Is a Safe Method in Patients with Small Cancer of the Breast. Long-Term Results of Three Randomised Trials on 1,973 Patients. European Journal of Cancer, 31A, 1574.
https://doi.org/10.1016/0959-8049(95)00271-J
[3]
Lim, M., Bellon, J.R., Gelman, R., et al. (2006) A Prospective Study of Conservative Surgery without Radiation Therapy in Select Patients with Stage I Breast Cancer. International Journal of Radiation Oncology, Biology, Physics, 65, 1149.
https://doi.org/10.1016/j.ijrobp.2006.02.006
[4]
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby, S., McGale, P., et al. (2011) Effect of Radiotherapy after Breast-Conserving Surgery on 10-Year Recurrence and 15-Year Breast Cancer Death: Meta-Analysis of Individual Patient Data for 10,801 Women in 17 Randomised Trials. The Lancet, 378, 1707.
https://doi.org/10.1016/S0140-6736(11)61629-2
[5]
Early Breast Cancer Trialists Collaborative Group (2005) Effects of Radiotherapy and of Differences in the Extent of Surgery for Early Breast Cancer on Local Recurrence and 15-Year Survival: An Overview of the Randomised Trials. The Lancet, 366, 2087-2106. https://doi.org/10.1016/S0140-6736(05)67887-7
[6]
Kavanagh, B.D. and Timmerman, R.D. (2006) Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy: An Overview of Technical Considerations and Clinical Applications. Hematology/Oncology Clinics of North America, 20, 87-95.
https://doi.org/10.1016/j.hoc.2006.01.009
[7]
Schulz-Ertner, D., Jakel, O. and Schlegel, W. (2006) Radiation Therapy with Charged Particles. Seminars in Radiation Oncology, 16, 249-259.
https://doi.org/10.1016/j.semradonc.2006.04.008
[8]
Rutqvist, L.E., Rose, C. and Cavallin-Stahl, E. (2003) A Systematic Overview of Radiation Therapy Effects in Breast Cancer. Acta Oncologica, 42, 532-545.
https://doi.org/10.1080/02841860310014444
[9]
Fenwick, J.D., Tomé, W.A., Soisson, E.T., et al. (2006) Tomotherapy and Other Innovative IMRT Delivery Systems. Seminars in Radiation Oncology, 16, 199-208.
https://doi.org/10.1016/j.semradonc.2006.04.002
[10]
Kurul, S., Dincer, M., Kizir, A., Uzunismail, A. and Darendeliler, E. (1997) Plastic Surgery in Irradiated Areas: Analysis of 200 Consecutive Cases. European Journal of Surgical Oncology, 23, 48-53. https://doi.org/10.1016/S0748-7983(97)80142-4
[11]
Olsen, D.R., Bruland, O.S., Frykholm, G. and Norderhaug, I.N. (2007) Proton Therapy—A Systematic Review of Clinical Effectiveness. Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology, 83, 123-132. https://doi.org/10.1016/j.radonc.2007.03.001
[12]
Patel, R.R. and Arthur, D.W. (2006) The Emergence of Advanced Brachytherapy Techniques for Common Malignancies. Hematology/Oncology Clinics of North America, 20, 97-118. https://doi.org/10.1016/j.hoc.2006.01.008
[13]
Daly, M., Junor, E.J. and Harnett, A.N. (1995) Late Effects after Radiotherapy for Breast Cancer. BMJ, 310, 669. https://doi.org/10.1136/bmj.310.6980.669b
[14]
Pignol, J.P., Olivotto, I., Rakovitch, E., Gardner, S., Sixel, K., Beckham, W., et al. (2008) A Multicenter Randomized Trial of Breast Intensity-Modulated Radiation Therapy to reduce Acute Radiation Dermatitis. Journal of Clinical Oncology, 26, 2085-2092. https://doi.org/10.1200/JCO.2007.15.2488
[15]
Emami, B., Lyman, J., Brown, A., Coia, L., Goitein, M., Munzenrider, J.E., et al. (1991) Tolerance of Normal Tissues to Therapeutic Radiation. International Journal of Radiation Oncology, Biology, Physics, 21, 109-122.
https://doi.org/10.1016/0360-3016(91)90171-Y
[16]
Porock, D. and Kristjanson, L. (1999) Skin Reactions during Radiotherapy for Breast Cancer: The Use and Impact of Topical Agents and Dressings. European Journal of Cancer Care, 8, 143-153.
https://doi.org/10.1046/j.1365-2354.1999.00153.x
[17]
The START Trialists’ Group (2008) The UK Standardisation of Breast Radiotherapy (START) Trial B of Radiotherapy Hypofractionation for Treatment of Early Breast: A Randomised Trial. The Lancet, 371, 1098-1107.
https://doi.org/10.1016/S0140-6736(08)60348-7
[18]
Rowsell, A.R., Eisenberg, N., Davies, D.M. and Taylor, G.I. (1986) The Anatomy of the Thoracodorsal Artery within the Latissimus Dorsi Muscle. British Journal of Plastic Surgery, 39, 206-209. https://doi.org/10.1016/0007-1226(86)90083-4
[19]
Brooks, D. and Buntic, R.F. (2008) Partial Muscle Harvest: Our First 100 Cases Attempting to Preserve Form and Function at the Donor Site. Microsurgery, 28, 606-611. https://doi.org/10.1002/micr.20575
[20]
Buntic, R.F., Horton, K.M., Brooks, D. and Lee, C.K. (2008) The Free Partial Superior Latissimus Muscle Flap: Preservation of Donor-Site Form and Function. Plastic and Reconstructive Surgery, 121, 1659-1663.
https://doi.org/10.1097/PRS.0b013e31816a9fa3
[21]
Overgaard, M., Hansen, P.S., Overgaard, J., et al. (1997) Postoperative Radiotherapy in High-Risk Premenopausal Women with Breast Cancer Who Receive Adjuvant Chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. The New England Journal of Medicine, 337, 949-955.
https://doi.org/10.1056/NEJM199710023371401
[22]
Ragaz, J., Jackson, S.M., Le, N., et al. (1997) Adjuvant Radiotherapy and Chemotherapy in Node-Positive Premenopausal Women with Breast Cancer. The New England Journal of Medicine, 337, 956-962.
https://doi.org/10.1056/NEJM199710023371402
[23]
Collins, E. and Collins, C. (1935) Roentgen Dermatitis Treated with Fresh Whole Leaf of Aloe Vera. American Journal of Roentgenology, 33, 396-397.
[24]
Schmuth, M., Wimmer, M.A., Hofer, S., Sztankay, A., Weinlich, G., Linder, D.M., et al. (2002) Topical Corticosteroid Therapy for Acute Radiation Dermatitis: A Prospective, Randomized, Double-Blind Study. British Journal of Dermatology, 146, 983-991. https://doi.org/10.1046/j.1365-2133.2002.04751.x
[25]
Saito, A., Saito, N., Funayama, E. and Minakawa, H. (2013) The Surgical Treatment of Irradiated Wounds: A Report on 36 Patients. Plastic Surgery: An International Journal, 2013, Article ID: 874416.
[26]
Fujioka, M. (2014) Surgical Reconstruction of Radiation Injuries. Advances in Wound Care, 3, 25-37. https://doi.org/10.1089/wound.2012.0405
[27]
Makboula, M. and Salama Ayyadb, M.A.K. (2012) Is Myocutaneous Flap Alone Sufficient for Reconstruction of Chest Wall Osteoradionecrosis? Interactive CardioVascular and Thoracic Surgery, 15, 447-451. https://doi.org/10.1093/icvts/ivs146
[28]
Krupp, S. and Guignard, R.-M. (1984) Treatment of Thoracic Radionecrosis with Lower Rectus Musculocutaneous Flaps. Chirurgie Plastica, 7, 249-254.
https://doi.org/10.1007/BF00264298
