Follow-up/Toxicity

Question 1

What are the acute and late toxicities of whole breast RT?

Answer 1

Acute toxicities: fatigue, dermatitis, hyperpigmentation, desquamation, pneumonitis

Late toxicities: soft tissue fibrosis, telangiectasias, rib fractures, pulmonary fibrosis, cardiovascular Dz, 2nd RT-induced malignancy

Question 2

What is the rate of acute skin breakdown, and where does it typically occur with whole breast RT?

Answer 2

25%–30% of pts experience skin breakdown, most often in the inframammary fold or axillary sulcus.

Question 3

What % of women have a less than good or excellent cosmetic result after whole breast RT and lumpectomy?

Answer 3

20%–30% of pts have a more unfavorable cosmetic result.

Question 4

In a pt with breast cancer, what is the rate of lymphedema after whole breast RT é axillary LND? How does the RT technique affect risk?

Answer 4

15%–35% after RT + axillary LND; 5%–10% after RT and sentinel node Bx only. It is difficult to determine the RT effect b/c of other confounding tumor and Tx factors. However, retrospective studies suggest that tangent-only RT is associated with lower risk than directed nodal RT.

Question 5

What is the RR of cardiovascular Dz death after RT to left-sided breast cancer compared to right-sided breast cancer?

Answer 5

Studies from the pre-3D planning era suggest that RT for left-sided breast cancer is associated with an RR of 1.5–2 for cardiovascular Dz death compared to RT for right-sided breast cancer. This has not been confirmed in women treated using modern RT techniques.

Question 6

What is the risk of 2nd malignancy after whole breast RT?

Answer 6

The lifetime risk of 2nd malignancy after whole breast RT is 1%–2%.