Hughes L L, Styblo T M, Thoms W W, Schwarzmann S W, Landry J C, Heaton D, Carlson G W, Wood W C
Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.
Am J Clin Oncol. 1997 Aug;20(4):338-41. doi: 10.1097/00000421-199708000-00003.
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.
保乳治疗（BCT）已成为早期乳腺癌患者的标准治疗选择。我们观察到，在乳腺放疗前、放疗期间及放疗后，接受治疗的乳房出现蜂窝织炎这一并发症。回顾了5名女性患者的病例（中位随访时间28个月；范围24 - 65个月），她们在乳腺放疗前（n = 1）、放疗期间（n = 2）或放疗后（n = 2）发生了蜂窝织炎。对埃默里大学连续一系列接受保乳治疗的患者进行回顾，以确定这一并发症的发生率。5名女性中有4名接受了腋窝淋巴结清扫，清扫出的腋窝淋巴结中位数为14个（范围6 - 22个），均为阴性。4名患者中有2名出现腋窝血清肿，需要穿刺抽吸。在这4名患者中，仅对乳房进行了放疗。第5名患者未进行腋窝淋巴结清扫，接受了乳房及锁骨上/腋窝放疗。全乳中位剂量为50 Gy（范围46 - 50.4 Gy）。所有患者蜂窝织炎的临床特征均包括红斑、水肿、压痛和皮温升高。5名患者中有4名的蜂窝织炎反复出现。在我们这组保乳治疗患者中，这一并发症的发生率约为1%。同侧乳房蜂窝织炎可能是保乳治疗的复发性并发症，可在乳腺放疗前、放疗期间或放疗后出现。腋窝血清肿及穿刺抽吸似乎提示了一部分早期发生蜂窝织炎的高危患者。晚期蜂窝织炎可能由手术和放疗对血管及皮肤完整性造成改变的多种因素引起。建议及时诊断并给予适当的抗生素治疗。这个问题并不需要中断乳腺放疗疗程，也不一定会导致不良的美容效果。
