Intraoperative placement of MammoSite for breast brachytherapy treatment and seroma incidence

Ravi, Akkamma; Lee, Susan; Karsif, Karen; Osian, Adrian; Nori, Dattatreyudu

doi:10.1016/j.brachy.2009.08.010

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Volume 9, Issue 1 , Pages 76-80, January 2010

Intraoperative placement of MammoSite for breast brachytherapy treatment and seroma incidence

Akkamma Ravi
- Department of Radiation Oncology, New York Hospital Queens, Flushing, New York, NY
- Department of Radiation Oncology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY
- Corresponding author. Department of Radiation Oncology, New York Hospital Medical Center of Queens, 56-45, Main Street, Flushing, New York, NY 11355. Tel.: +1-718-670-1501; fax: +1-718-445-9846.
Susan Lee
- Department of Surgery, New York Hospital Queens, Flushing, New York, NY
Karen Karsif
- Department of Surgery, New York Hospital Queens, Flushing, New York, NY
Adrian Osian
- Department of Radiation Oncology, New York Hospital Queens, Flushing, New York, NY
Dattatreyudu Nori
- Department of Radiation Oncology, New York Hospital Queens, Flushing, New York, NY
- Department of Radiation Oncology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY

Received 7 May 2009; received in revised form 14 August 2009; accepted 20 August 2009. published online 23 October 2009.

Abstract

Purpose

To identify possible risk factors for development of clinically significant seroma (CSS) (seroma requiring intervention) and to report on incidence of infection after intraoperative placement of MammoSite for breast brachytherapy.

Methods and Materials

Fifty-eight postmenopausal patients with early stage breast cancer and no nodal metastases, treated with partial breast irradiation using the MammoSite catheter from June 2003 to November 2007 were analyzed retrospectively for CSS predictive factors and incidence of infection. After a lumpectomy, a MammoSite catheter was placed by intraoperative open-cavity technique (OCT). All the patients received wound care and prophylactic antibiotics. A dose of 3400cGy was prescribed at 1cm from the surface of the balloon and was delivered at 340 cGy twice daily 6h apart for 5 days. The patients with seroma who underwent intervention were considered to have CSS. On the basis of the characteristics and symptoms associated with seroma, interventions, such as aspiration, core biopsy, or re-excision of the lumpectomy cavity were performed either to relieve symptoms or to rule out a local recurrence.

Results

Fifty-seven of the 58 patients were eligible for analysis. One patient, who died 4 weeks after treatment from unrelated causes, was excluded from final analysis. All the patients were postmenopausal, with a median age of 71 years (range, 53–88 years). Eighteen of the 57 patients (31.5%) had CSS; 9 of them had re-excision of the lumpectomy cavity. Pathology in all revealed evidence of fat necrosis, chronic inflammatory cells, and fibrosis. There was no evidence of tumor recurrence in any of these patients. Technical and nontechnical parameters were analyzed to determine possible risk factors for CSS, and none were found to be statistically significant. No patient developed acute postprocedural infection.

Conclusions

Meticulous wound care and postoperative antibiotics prevented acute infection. Infection was not a contributing factor for seroma formation in these patients. Placement of the MammoSite catheter by OCT did not increase the risk of CSS development, in postmenopausal breast cancer patients.

Keywords: MammoSite, Accelerated partial breast irradiation, Seroma, Breast brachytherapy, Open-cavity technique