Capsular contracture of subcutaneous breast implant following hypofractionated stereotactic body radiotherapy for early stage lung cancer
Mary Frances McAleer, Peter Balter, M. Kara Bucci, Shirley Kuruvila, Ritsuko Komaki and Joe Y. Chang
Background: Development of capsular contracture around subcutaneously implanted breast prostheses, producing poor cosmetic outcome and pain, has been reported following standard fractionated external beam radiotherapy to whole implants for breast cancer. We report capsular contracture following partial implant irradiation from hypofractionated stereotactic body radiotherapy (SBRT) for lung cancer in a 64 year-old female with augmentation mammaplasty.
Methods: The patient had biopsy-proven, T1 non-small cell lung carcinoma, adjacent to the implant. She received 50 Gy in 4 fractions to 91% of planning target volume using a 7-field, 3D-conformal plan with 6 MV photons and daily CT-guided target localization. The implant received 9.3 Gy mean dose, 51.7 Gy maximum point dose, with V10 41%, V20 15% and V30 4%.
Results: At seven months, the patient reported left breast pain requiring narcotic analgesics and demonstrated modified Baker/Palmer grade 4 capsular contracture. Breast retraction assessment measurement increased from baseline 10.4 mm to 19.8 mm.
Conclusions: This represents the first reported case of capsular contracture from partial breast implant radiation following SBRT for lung cancer. Further investigation to elucidate maximum tolerated dose of radiation given to breast implants in this setting is needed.
Keywords: Stereotactic Body Radiotherapy, Lung Cancer, Breast Implant Capsular Contracture