Case Report Partial breast irradiation in a patient with bilateral breast cancers and CREST syndrome Nicole Kounalakis 1, * , Richard Pezner 2 , Cecil L. Staud 3 , Laura Kruper 4 1 Department of Surgery, University of Colorado Medical Center, Aurora, CO 2 Department of Radiation Oncology, City of Hope Medical Center, Duarte, CA 3 Department of Radiation Physics, City of Hope Medical Center, Duarte, CA 4 Department of General and Surgical Oncology, City of Hope Medical Center, Duarte, CA ABSTRACT PURPOSE: To describe the first documented use of partial breast irradiation (PBI) in a patient with calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias (CREST) syndrome. METHODS AND MATERIALS: A 50-year-old woman with well-controlled CREST syndrome for 6 years was diagnosed with bilateral early-staged breast cancers. She underwent bilateral lump- ectomies, sentinel lymph node biopsies, and PBI delivered via bilateral MammoSite catheters (Cytyc Corp., Marlborough, MA) followed by chemotherapy. She was monitored perioperatively, at 6 months and at 1 year for worsening of her CREST-related symptoms and complications asso- ciated with surgery and radiation therapy. Both surgeon and patient’s opinion of her cosmetic outcome were also recorded at 1-year followup. RESULTS: The patient experienced mild acute cellulitic changes in the perioperative period, which resolved with antibiotics. At 6 months, she exhibited a Grade 1 late toxicity, which has remained stable at 1-year followup. The patient and surgeon are very pleased with her cosmetic outcome. CONCLUSIONS: Accelerated PBI was delivered safely to a patient with collagen vascular disease. By decreasing the surface area receiving radiation with accelerated PBI, we believe that the toxicity associated with the treatment was minimized. Future studies will be necessary to clarify the use of PBI in patients with collagen vascular disease. Ó 2011 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved. Keywords: Accelerated breast irradiation; MammoSite catheter; Breast cancer; CREST syndrome Introduction For patients with breast cancer and collagen vascular disease (CVD), radiation therapy (RT) after breast conser- vation surgery is very controversial. Given the increased incidence of fibrosis, poor wound healing, and compro- mised cosmesis, many physicians consider RT to be contra- indicated in patients with CVD (1e3). This leaves mastectomy as the only surgical option. Several studies have shown that adjuvant accelerated partial breast irradiation (APBI) using the MammoSite (Cytyc Corp., Marlborough, MA) balloon catheter for early-staged breast cancer yields equivalent treatment efficacy, cosmesis, and toxicity to other forms of APBI and to whole breast radiation (4, 5). The use of APBI in patients with CVD has not yet been evaluated in the literature. We describe a patient with CREST syndrome and bilateral breast cancer. CREST syndrome is a collagen vascular disease in which the patient exhibits at least 2 of the following symptoms: calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclero- dactyly, and telangiectasias. She was treated with breast conserving surgery and adjuvant APBI administered via bilateral MammoSite catheters. Case report A 50-year-old perimenopausal woman presented with a palpable left breast mass. Her medical history was Received 10 December 2010; received in revised form 18 January 2011; accepted 19 January 2011. Financial disclosure: No financial disclosure/conflict of interests to reveal for any of the authors. * Corresponding author. Department of Surgery, Mail Stop C313, 12631 East 17th Avenue, Room 6001, Aurora, CO 80045. Tel.: þ1-303- 724-2728; fax: þ1-303-724-2733. E-mail address: nicole.kounalakis@ucdenver.edu (N. Kounalakis). 1538-4721/$ - see front matter Ó 2011 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved. doi: 10.1016/j.brachy.2011.01.010 Brachytherapy 10 (2011) 486e490