[The esthetic results in patients undergoing postoperative radiotherapy in breast carcinoma]. / Risultati estetici nelle pazienti sottoposte a radioterapia postoperatoria nel carcinoma mammario.

ABSTRACT

INTRODUCTION: Early stage breast cancer (pT-T2, N0, N+, M0) is generally treated with conservative surgery followed by radiation therapy, which procedures yield similar results to radical surgery. We studied the effects of irradiation on residual breast parenchyma in patients submitted to quadrantectomy and complementary irradiation. MATERIAL AND METHODS: 331 patients (Stage T1, T2, N0, M0) submitted to quadrantectomy and axillary dissection 1980-1993, were examined. The tumor was localized in external quadrants in 257 cases and in internal ones in 74 cases. Radiotherapy was given with 4-6 MV photon beams produced by a linear accelerator; the total dose to the breast was 50 Gy with a 10 Gy boost to tumor bed. All the patients were submitted to follow-up mammography at 6 months, one and two years after the end of radiotherapy. Parenchymal density was evaluated on an arbitrary scale from 0 to 3. We also considered the following other parameters skin thickness, calcifications, cysts and possible signs of recurrence. RESULTS: Trabecular patterns were unchanged in 41 patients (grade 0) and slightly changed in 67 (grade 1); 135 patients had grade 2 and 90 grade 3 changes. 254 patients had skin thickening. All the changes disappeared at 2-3 years' follow-up. The patients with bigger breasts had poorer cosmetic results. CONCLUSIONS: It is very important to assess irradiation-induced tissue changes to detect any early recurrence of breast carcinoma. All radiation-induced changes decrease over time, which confirms the good tolerance and the good cosmetic results of complementary irradiation for breast cancer