Breast pseudotumoral radionecrosis as a late radiation-induced injury: a case report

Abstract:

Introduction:
New therapies and treatment protocols have led to improved survival rates in many cancers. The improved rates are such that patients are now living long enough to experience some negative long-term side effects of the initial therapy.

Case presentation:
We report the case of a 65-year-old Caucasian woman who presented with a rare case of pseudotumoral radionecrosis, a late radiation-induced injury, after combined surgical and cobalt radiation therapy for the treatment of adenocarcinoma of the right breast. The patient underwent resection of this benign, yet progressively growing and painful tumor. A cosmetically satisfying result was achieved by reconstruction of the thoracic wall with a polypropylene mesh and a latissimus dorsi muscle flap.

Conclusion:
With improved overall survival, new management strategies for late side effects of therapy are becoming of crucial importance for affected patients. In the future, improving toxicityfree survival will be as important as achieving disease-free survival or local tumor control.

Disclosure: © 2009 Gerullis et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 22 April 2008 Accepted: 8 October 2009

Correspondence: Address: 1.Department for General and Thoracic Surgery, DRK Clinics, Drontheimer Strasse, Berlin 13359, Germany, 2.West German Cancer Center(WTZ), University of Essen, 45122 Essen, Germany and 3Montefiore Medical Center, Department of Medical Oncology, The Albert Einstein Cancer Center, Bronx, NY 10467, USA

Email: Holger Gerullis* - holger.gerullis@gmx.net; Christoph Johann Heuck - cheuck@montefiore.org; Paul Schneider - chirurgie@drkklinikenmarkbrandenburg.de
Corresponding author

Journal of Medical Case Reports 2009, 3:71 doi:10.1186/1752-1947-3-71
This article is available from: www.jmedicalcasereports.com

Introduction
With the increasing number of long-term survivors who have been treated with newer anticancer therapy strategies, we encounter increasing numbers of sequelae from earlier therapeutic approaches. These long-term side effects are an important factor in the patient's quality of life, both psychologically and somatically, and must be addressed in the treatment of the underlying disease.

Radiation-induced fibroatrophy (RIF) is a rare late sequela of high-dose radiation therapy. It is localized to the radiation field and is usually irreversible. The pathologic manifestation of this entity can be limited to skin dryness, hyperpigmentation or telangiectasia. This superficial damage, however, may also be combined with underlying fibronecrotic lesions affecting the pleura and lungs resulting in pulmonary fibrosis, neurological disorders secondary to the development of perineural fibrosis, or spontaneous rib fractures due to osteoradionecrosis 1-3. We report the excellent cosmetic and functional results after surgical treatment in a particular clinical setting of pseudotumoral radionecrosis as a late radiation-induced injury after initial anticancer treatment.