The British journal of radiology · 2026
Endocrine therapy increases risk of fat necrosis risk after lumpectomy and intraoperative radiation therapy in early-stage breast cancer.
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Scherer Christophe, Fung Vivien, Anzellini Dimitri, Osti Mattia Falchettto, Doridot Virginie, Muracciole Xavier, Nappa Mario, Mesurolle Benoît, Loganadane Gokoulakrichenane
Аннотация
OBJECTIVES: The incidence of fat necrosis (FN) is well known (15%-35%) with accelerated partial breast irradiation (APBI) techniques such as brachytherapy and external beam radiation therapy. However, specific data related to intraoperative radiation therapy (IORT) is lacking.
METHODS: This retrospective cohort study was conducted in a single institution with 489 post-menopausal female patients >45-year-old with early-stage invasive breast cancer (T1-2N0M0) who underwent lumpectomy and IORT between March 2016 and June 2023. The median age was 68 years (range, 49-93). WBRT was additionally offered in 36 patients (7.4%) for exhibiting local adverse features. Adjuvant endocrine therapy (consisting of aromatase inhibitors) and chemotherapy were administrated in 384 patients (78.5%) and 12 patients (2.4%), respectively. The incidence and potential predictors of fat necrosis were reviewed.
RESULTS: Median follow-up was 36 months, the 3-year incidence of FN was 63.1% (95% CI, 58.2%-68%). Grade 1, grade 2, and grade 3 FN were present in 278 (57%), 10 patients (2%), and 3 patients (0.6%), respectively. The median FN size was 22 mm (range, 5-50). Adjuvant endocrine therapy but not whole breast radiation therapy was found to be the only independent predictor associated with significantly increased risk of FN (1.77 [95% CI, 1.14-2.76], P = .01).
CONCLUSIONS: IORT carries a higher largely asymptomatic FN incidence. Risk increases with aromatase inhibitors, not with WBRT. Endocrine therapy should not be withheld, and asymptomatic FN should not alter routine surveillance.
ADVANCES IN KNOWLEDGE: Endocrine therapy is associated with increased risk of fat necrosis after lumpectomy and IORT.
METHODS: This retrospective cohort study was conducted in a single institution with 489 post-menopausal female patients >45-year-old with early-stage invasive breast cancer (T1-2N0M0) who underwent lumpectomy and IORT between March 2016 and June 2023. The median age was 68 years (range, 49-93). WBRT was additionally offered in 36 patients (7.4%) for exhibiting local adverse features. Adjuvant endocrine therapy (consisting of aromatase inhibitors) and chemotherapy were administrated in 384 patients (78.5%) and 12 patients (2.4%), respectively. The incidence and potential predictors of fat necrosis were reviewed.
RESULTS: Median follow-up was 36 months, the 3-year incidence of FN was 63.1% (95% CI, 58.2%-68%). Grade 1, grade 2, and grade 3 FN were present in 278 (57%), 10 patients (2%), and 3 patients (0.6%), respectively. The median FN size was 22 mm (range, 5-50). Adjuvant endocrine therapy but not whole breast radiation therapy was found to be the only independent predictor associated with significantly increased risk of FN (1.77 [95% CI, 1.14-2.76], P = .01).
CONCLUSIONS: IORT carries a higher largely asymptomatic FN incidence. Risk increases with aromatase inhibitors, not with WBRT. Endocrine therapy should not be withheld, and asymptomatic FN should not alter routine surveillance.
ADVANCES IN KNOWLEDGE: Endocrine therapy is associated with increased risk of fat necrosis after lumpectomy and IORT.