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Published in: Archives of Gynecology and Obstetrics 4/2016

01-10-2016 | Gynecologic Oncology

Comparison of seroma production in breast conserving surgery with or without intraoperative radiotherapy as tumour bed boost

Authors: Florian Ebner, Amelie Schramm, Dirk Bottke, Thomas WP Friedl, Thomas Wiegel, Visnja Fink, Kristian Lato, Inga Bekes, Wolfgang Janni, Nikolaus de Gregorio

Published in: Archives of Gynecology and Obstetrics | Issue 4/2016

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Abstract

Introduction

One of the most common complications in breast conserving surgery is seroma formation. The origin of seroma formation remains unclear. While intraoperative radiotherapy (IORT) has been shown to be an alternative to whole breast irradiation, the influence on seroma production is unclear. Therefore, this analysis compares seroma production in patients with breast conserving surgery with or without IORT as tumour bed boost during breast conserving surgery.

Method

A retrospective analysis of seroma production in patients with nodal-negative (pN0sn) pT1/2 primary breast cancer treated between September 2010 and October 2013 at the Breast Cancer Centre, University Hospital Ulm was performed. Patients with neoadjuvant chemotherapy, previous breast/axillary surgery or more than one intervention were excluded. IORT was applied as a tumour bed boost with 50-kV X-rays (Intra beam®) delivering 9 Gy at the applicator surface. Seroma formation was measured using wound drains placed in breast and in axilla.

Results

Data of 152 patients (99 −IORT; 53 +IORT) were available for analysis. No significant differences between patients with or without IORT with regard to seroma production and number of days until drain removal were found (all p > 0.05).

Conclusion

Patients with IORT encountered no increased seroma production and removal of the drains was not delayed compared to patients with breast conserving surgery only. Our results indicate that IORT does not increase the seroma production compared to surgery alone.
Literature
1.
go back to reference Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):1233–1241CrossRefPubMed Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):1233–1241CrossRefPubMed
2.
go back to reference Veronesi U, Luini A, Galimberti V, Zurrida S (1994) Conservation approaches for the management of stage I/II carcinoma of the breast: Milan Cancer Institute trials. World J Surg 18(1):70–75CrossRefPubMed Veronesi U, Luini A, Galimberti V, Zurrida S (1994) Conservation approaches for the management of stage I/II carcinoma of the breast: Milan Cancer Institute trials. World J Surg 18(1):70–75CrossRefPubMed
3.
go back to reference Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M 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. Lancet 378(9804):1707–1716CrossRefPubMed Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M 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. Lancet 378(9804):1707–1716CrossRefPubMed
4.
go back to reference Bartelink H, Horiot J-C, Poortmans PM, Struikmans H, Van den Bogaert W, Fourquet A et al (2007) Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol 25(22):3259–3265CrossRefPubMed Bartelink H, Horiot J-C, Poortmans PM, Struikmans H, Van den Bogaert W, Fourquet A et al (2007) Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol 25(22):3259–3265CrossRefPubMed
5.
go back to reference Boostrom SY, Throckmorton AD, Boughey JC, Holifield AC, Zakaria S, Hoskin TL et al (2009) Incidence of clinically significant seroma after breast and axillary surgery. J Am Coll Surg 208(1):148–150CrossRefPubMed Boostrom SY, Throckmorton AD, Boughey JC, Holifield AC, Zakaria S, Hoskin TL et al (2009) Incidence of clinically significant seroma after breast and axillary surgery. J Am Coll Surg 208(1):148–150CrossRefPubMed
6.
go back to reference Srivastava V, Basu S, Shukla VK (2012) Seroma formation after breast cancer surgery: what we have learned in the last two decades. J Breast Cancer. 15(4):373–380CrossRefPubMedPubMedCentral Srivastava V, Basu S, Shukla VK (2012) Seroma formation after breast cancer surgery: what we have learned in the last two decades. J Breast Cancer. 15(4):373–380CrossRefPubMedPubMedCentral
7.
go back to reference Buchholz TA, Somerfield MR, Griggs JJ, El-Eid S, Hammond MEH, Lyman GH et al (2014) Margins for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer: American Society of Clinical Oncology endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology consensus guideline. J Clin Oncol 32(14):1502–1506CrossRefPubMed Buchholz TA, Somerfield MR, Griggs JJ, El-Eid S, Hammond MEH, Lyman GH et al (2014) Margins for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer: American Society of Clinical Oncology endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology consensus guideline. J Clin Oncol 32(14):1502–1506CrossRefPubMed
8.
go back to reference Ebner FK, Friedl TWP, Reich A, Janni W, Rempen A, Degregorio N et al (2013) Does non-placement of a drain in breast surgery increase the rate of complications and revisions? Geburtshilfe Frauenheilkd 73(11):1128–1134CrossRefPubMedPubMedCentral Ebner FK, Friedl TWP, Reich A, Janni W, Rempen A, Degregorio N et al (2013) Does non-placement of a drain in breast surgery increase the rate of complications and revisions? Geburtshilfe Frauenheilkd 73(11):1128–1134CrossRefPubMedPubMedCentral
9.
go back to reference Garbay J-R, Thoury A, Moinon E, Cavalcanti A, Di Palma M, Karsenti G et al (2012) Axillary padding without drainage after axillary lymphadenectomy—a prospective study of 299 patients with early breast cancer. Breast Care (Basel) 7(3):231–235CrossRef Garbay J-R, Thoury A, Moinon E, Cavalcanti A, Di Palma M, Karsenti G et al (2012) Axillary padding without drainage after axillary lymphadenectomy—a prospective study of 299 patients with early breast cancer. Breast Care (Basel) 7(3):231–235CrossRef
12.
go back to reference Malter W, Kirn V, Richters L, Fridrich C, Markiefka B, Bongartz R et al (2014) Intraoperative boost radiotherapy during targeted oncoplastic breast surgery: overview and single center experiences. Int J Breast Cancer. 2014:637898CrossRefPubMedPubMedCentral Malter W, Kirn V, Richters L, Fridrich C, Markiefka B, Bongartz R et al (2014) Intraoperative boost radiotherapy during targeted oncoplastic breast surgery: overview and single center experiences. Int J Breast Cancer. 2014:637898CrossRefPubMedPubMedCentral
13.
go back to reference Cracco S, Semprini G, Cattin F, Gregoraci G, Zeppieri M, Isola M et al (2015) Impact of intraoperative radiotherapy on cosmetic outcome and complications after oncoplastic breast surgery. Breast J. 21(3):285–290CrossRefPubMed Cracco S, Semprini G, Cattin F, Gregoraci G, Zeppieri M, Isola M et al (2015) Impact of intraoperative radiotherapy on cosmetic outcome and complications after oncoplastic breast surgery. Breast J. 21(3):285–290CrossRefPubMed
14.
go back to reference Kraus-Tiefenbacher U, Bauer L, Kehrer T, Hermann B, Melchert F, Wenz F (2006) Intraoperative radiotherapy (IORT) as a boost in patients with early-stage breast cancer – acute toxicity. Onkologie. 29(3):77–82PubMed Kraus-Tiefenbacher U, Bauer L, Kehrer T, Hermann B, Melchert F, Wenz F (2006) Intraoperative radiotherapy (IORT) as a boost in patients with early-stage breast cancer – acute toxicity. Onkologie. 29(3):77–82PubMed
15.
go back to reference Merdad AA, Bahadur YA, Fawzy EE, Hassouna AH, Eltaher MM, Alghaithy ZK et al (2013) Phase II study on the use of intraoperative radiotherapy in early breast cancer. Saudi Med J 34(11):1133–1138PubMed Merdad AA, Bahadur YA, Fawzy EE, Hassouna AH, Eltaher MM, Alghaithy ZK et al (2013) Phase II study on the use of intraoperative radiotherapy in early breast cancer. Saudi Med J 34(11):1133–1138PubMed
16.
go back to reference Ruano-Ravina A, Cantero-Muñoz P, Eraso Urién A (2011) Efficacy and safety of intraoperative radiotherapy in breast cancer: a systematic review. Cancer Lett 313(1):15–25CrossRefPubMed Ruano-Ravina A, Cantero-Muñoz P, Eraso Urién A (2011) Efficacy and safety of intraoperative radiotherapy in breast cancer: a systematic review. Cancer Lett 313(1):15–25CrossRefPubMed
17.
go back to reference Sedlmayer F, Reitsamer R, Fussl C, Ziegler I, Zehentmayr F, Deutschmann H et al (2014) Boost IORT in breast cancer: body of evidence. Int J Breast Cancer. 2014:472516CrossRefPubMedPubMedCentral Sedlmayer F, Reitsamer R, Fussl C, Ziegler I, Zehentmayr F, Deutschmann H et al (2014) Boost IORT in breast cancer: body of evidence. Int J Breast Cancer. 2014:472516CrossRefPubMedPubMedCentral
18.
go back to reference Tuschy B, Berlit S, Romero S, Sperk E, Wenz F, Kehl S et al (2013) Clinical aspects of intraoperative radiotherapy in early breast cancer: short-term complications after IORT in women treated with low energy x-rays. Radiat Oncol 8:95CrossRefPubMedPubMedCentral Tuschy B, Berlit S, Romero S, Sperk E, Wenz F, Kehl S et al (2013) Clinical aspects of intraoperative radiotherapy in early breast cancer: short-term complications after IORT in women treated with low energy x-rays. Radiat Oncol 8:95CrossRefPubMedPubMedCentral
19.
go back to reference Kraus-Tiefenbacher U, Welzel G, Brade J, Hermann B, Siebenlist K, Wasser KS et al (2010) Postoperative seroma formation after intraoperative radiotherapy using low-kilovoltage X-rays given during breast-conserving surgery. Int J Radiat Oncol Biol Phys 77(4):1140–1145CrossRefPubMed Kraus-Tiefenbacher U, Welzel G, Brade J, Hermann B, Siebenlist K, Wasser KS et al (2010) Postoperative seroma formation after intraoperative radiotherapy using low-kilovoltage X-rays given during breast-conserving surgery. Int J Radiat Oncol Biol Phys 77(4):1140–1145CrossRefPubMed
20.
go back to reference Glechner A, Wöckel A, Gartlehner G, Thaler K, Strobelberger M, Griebler U et al (2013) Sentinel lymph node dissection only versus complete axillary lymph node dissection in early invasive breast cancer: a systematic review and meta-analysis. Eur J Cancer 49(4):812–825. doi:10.1016/j.ejca.2012.09.010 CrossRefPubMed Glechner A, Wöckel A, Gartlehner G, Thaler K, Strobelberger M, Griebler U et al (2013) Sentinel lymph node dissection only versus complete axillary lymph node dissection in early invasive breast cancer: a systematic review and meta-analysis. Eur J Cancer 49(4):812–825. doi:10.​1016/​j.​ejca.​2012.​09.​010 CrossRefPubMed
21.
go back to reference Kuroi K, Shimozuma K, Taguchi T, Imai H, Yamashiro H, Ohsumi S et al (2006) Evidence-based risk factors for seroma formation in breast surgery. Jpn J Clin Oncol 36(4):197–206CrossRefPubMed Kuroi K, Shimozuma K, Taguchi T, Imai H, Yamashiro H, Ohsumi S et al (2006) Evidence-based risk factors for seroma formation in breast surgery. Jpn J Clin Oncol 36(4):197–206CrossRefPubMed
Metadata
Title
Comparison of seroma production in breast conserving surgery with or without intraoperative radiotherapy as tumour bed boost
Authors
Florian Ebner
Amelie Schramm
Dirk Bottke
Thomas WP Friedl
Thomas Wiegel
Visnja Fink
Kristian Lato
Inga Bekes
Wolfgang Janni
Nikolaus de Gregorio
Publication date
01-10-2016
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 4/2016
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-016-4124-8

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