Complications and local relapse after intraoperative low-voltage X-ray radiotherapy in breast cancer.

PURPOSE: To study those factors that influence the occurrence of surgical complications and local relapse in patients intervened for breast cancer and receiving intraoperative radiotherapy. METHODS: Observational study on patients intervened for breast cancer with conservative surgery and intraoperative radiotherapy with low-voltage X-ray energy source (INTRABEAM), from 2015 to 2017 with 24 months minimum follow-up. Variables possibly associated to the occurrence of postoperative complications were analyzed with the Student t-test and the Fisher exact test; P < 0.05 considered significant. Subsequently, the construction of multiple multivariate analysis models began, thus building a logistic regression analysis using the IBM SPSS Statistics ver. 23 software. Local relapse was described. RESULTS: The study included 102 patients, mean age of 61.2 years; mean global size of tumor, 12.2 mm. Complications occurred in 29.4%. Fibrosis was the most frequently observed complication, followed by postoperative seroma. Using a 45 mm or larger applicator were significantly associated with the occurrence of complications. Tumor size 2 cm or larger and reintervention showed borderline significant association. Only one case of local relapse was observed. CONCLUSION: Certain factors may increase the risk of complication after the use of intraoperative radiotherapy. Using external complementary radiotherapy does not seem to increase the rate of complications. Select patients and the involvement of a multidisciplinary team are essential for achieving good results.

Inverse radiotherapy planning in reconstructive surgery for breast cancer.

BACKGROUND: Post-mastectomy radiotherapy reduces the risk of local-regional relapse and distant disease, and increases global survival in women with axillary involvement. With the new reconstruction techniques and increasing use of directed external radiotherapy, immediate reconstruction can be performed with good cosmetic results and low complication rates. MATERIALS AND METHODS: Observational study with consecutive sampling conducted in patients undergoing reconstructive surgery for breast cancer, between 2010 and 2016, with a 12-months minimum follow-up period. A group of patients radiated after receiving an expander (RT-Expander) were compared with a control group of non-radiated patients (Non-RT), who had been treated with the same surgical technique. We compare general complications, reconstruction failure, aesthetic results and satisfaction degree with software IBM® SPSS® Statistics v. 21 and BREAST-Q scores. RESULTS: Reconstruction failure was observed in 15.6% of patients in a similar proportion in both groups. External radiotherapy was not an independent significant factor influencing the occurrence of general complications, capsular contracture grade ≥3 or reconstruction failure. The Kaplan-Meyer curve showed no differences in reconstruction survival between groups. Aesthetic results were excellent-very good in 78.1% of patients. Absence of a contralateral procedure for symmetrization, occurrence of general complications, occurrence of capsular contracture grade ≥3 and reconstruction failure were significantly associated to fair-poor cosmetic results. The satisfaction degree of operated patients was similar in both groups. CONCLUSIONS: The evolution of external radiotherapy towards more directed techniques, which modulate the dose administered to the mammary tissue and adjacent structures, allowed us to make immediate reconstruction a reality for most patients, with complication rates, cosmetic results and satisfaction degrees similar to those of non-radiated patients.