Cellulitis of the breast as a complication of breast-conserving surgery and irradiation.

Cellulitis of the breast as a complication of breast-conserving surgery and irradiation.

Hughes LL,
Styblo TM,
Thoms WW,
Schwarzmann SW,
Landry JC,
Heaton D,
Carlson GW,
Wood WC.
Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.

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 approximately 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.

PMID: 9256885 [PubMed - indexed for MEDLINE]

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Delayed cellulitis associated with conservative therapy for breast cancer.

Miller SR,
Mondry T,
Reed JS,
Findley A,
Johnstone PA.

Breast Health Center, Naval Medical Center, San Diego, California 92134-5000, USA.

BACKGROUND AND OBJECTIVES:

Delayed breast cellulitis is an infrequently reported entity after conservation therapy for breast cancer. We describe our experience with this entity at Naval Medical Center, San Diego.

METHODS:

Eight patients who presented with delayed cellulitis after wide local excision/axillary dissection and breast radiotherapy (RT) are presented. Their clinical characteristics and therapy are described and possible causative factors are analyzed.

RESULTS:

The latency of breast cellulitis is variable after breast conservation therapy, although most cases in our experience and in the literature occur within a year post-RT. These infections are frequently refractory to a single course of antibiotics (n = 4 cases in our experience). Some patients suffer multiple episodes separated by months.

CONCLUSIONS:

Breast cancer patients are at risk for delayed cellulitis after conservative surgery and RT. The mechanism of such events probably involves lymph stasis, however, therapy is no different from the more frequently occurring cases of cellulitis presenting perioperatively.

PMID: 9579371 [PubMed - indexed for MEDLINE]

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Delayed breast cellulitis following breast conserving operation.

Zippel D,
Siegelmann-Danieli N,
Ayalon S,
Kaufman B,
Pfeffer R,
Zvi Papa M.
Department of Surgical Oncology, Chaim Sheba Medical Center, Israel.

A complication of breast conservation, which has been increasingly reported in the literature, is 'delayed cellulitis' in the treated breast. This is to be distinguished from wound infection in the breast following lumpectomy.

This study reports 16 cases diagnosed with delayed cellulitis following breast conserving surgery, unresponsive to antibiotic therapy. Diagnostic criteria included: pain, erythema and edema in the operated breast. Symptoms appeared up to 10 months after surgery and time to resolution was seven and a half months. No patients had positive cytology and bacteriology tests were negative. Thirteen patients were observed, and three patients were treated with antibiotics with no apparent immediate effect.

The appearance of breast cellulitis after surgery poses a problematic diagnostic and management dilemma. It is important to distinguish between this entity and infection, or inflammatory carcinoma. The picture may be attributed to impairment or occlusion of the lymphatic circulation in the breast. This seems to be a newly defined complication with an incidence of 3-5%.

PMID: 12711284 [PubMed - indexed for MEDLINE]

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The dilemma of delayed cellulitis after breast conservation therapy.

Staren ED,
Klepac S,
Smith AP,
Hartsell WF,
Segretti J,
Witt TR,
Griem KL,
Bines SD.
Department of General Surgery, Rush-Presbyterian-St Luke's Medical Center, Chicago, III, USA.

OBJECTIVE:

To determine the clinicopathologic characteristics of patients with breast cancers in whom delayed breast cellulitis developed after conservation therapy (lumpectomy, axillary dissection, and radiation).

BACKGROUND:

Breast cellulitis developing after conservation therapy represents a difficult diagnostic and management dilemma because determination of its origin may be necessary before further treatment decisions can be made.

METHODS:

In this retrospective evaluation of 184 sequential patients with breast cancers who underwent conservation therapy, 10 study patients (5%) in whom breast cellulitis developed 3 or more months after surgery were compared with the 174 patients in whom cellulitis did not develop.

RESULTS:

There was no significant difference in clinicopathologic characteristics of the study patients compared with control patients. The cellulitis resolved in 5 patients (50%) and persisted from 4 months to more than 1 year in 5 patients (50%). The cellulitis recurred in 1 patient who responded to repeated therapy. The 5 patients with persistent cellulitis underwent biopsies, and recurrent cancer was found in 1 patient. Recurrent cancer did not develop in the patients whose cellulitis resolved within 4 months with a minimum follow-up of 24 months.

CONCLUSIONS:

Delayed-onset cellulitis occurs in a small percentage of patients with breast cancers treated by conservation therapy. The cellulitis may take several weeks to clear, and/or it may recur or persist. If the condition persists after 4 months of therapy, a biopsy should be performed to rule out recurrent cancer.

PMID: 8645074 [PubMed - indexed for MEDLINE]

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Breast cellulitis after conservative surgery and radiotherapy.

Rescigno J,
McCormick B,
Brown AE,
Myskowski PL.
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY.

PURPOSE:

Cellulitis is a previously unreported complication of conservative surgery and radiation therapy for early stage breast cancer. Patients who presented with breast cellulitis after conservative therapy are described.

METHODS AND MATERIALS:

Eleven patients that developed cellulitis of the breast over a 38-month period of observation are the subject of this report. Clinical characteristics of patients with cellulitis and their treatment and outcome are reported. Potential patient and treatment-related correlates for the development of cellulitis are analyzed.

RESULTS:

The risk of cellulitis persists years after initial breast cancer therapy. The clinical course of our patients was variable: some patients required aggressive, long-duration antibiotic therapy, while others had rapid resolution with antibiotics. Three patients suffered from multiple episodes of cellulitis.

CONCLUSION:

Patients with breast cancer treated with conservative surgery and radiotherapy are at risk for breast cellulitis. Systematic characterization of cases of cellulitis may provide insight into diagnosis, prevention, and more effective therapy for this uncommon complication.

PMID: 8175424 [PubMed - indexed for MEDLINE]