Fat necrosis may follow stereotactic partial breast irradiation (S-PBI) for early-stage breast cancer. Rahimi et al identified risk factors for fat necrosis, which can be painful. The authors are from University of Texas Southwestern, Columbia University and Memorial Health Care System (Miramar, Florida).
Patient selection: early-stage breast cancer, breast conserving surgery, status post stereotactic partial breast irradiation (S-PBI)
Onset of breast necrosis may range from 3 to 42 months with median 12-13 months.
Risk factors for painful fat necrosis:
(1) delivering fractions on consecutive days
(2) breast volume > 1000 cc
(3) excessive volume irradiated (see table)
(4) maximum dose (Dmax)> 48 Gy
(5) planning target volume (PTV)>= 100 cc
Dose
Volume Irradiated
37.5 Gy
>= 95 cc
40 Gy
>= 85 cc
42.5 Gy
>= 50 cc
45 Gy
>= 20 cc
47.5 Gy
>= 1 cc
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