BOSTON – The appearance of radiation-induced telangectasias of the breast can be significantly improved by treatment with a pulsed-dye laser, investigators reported at the annual meeting of the American Society for Laser Medicine and Surgery.
There were no adverse treatment-associated effects, and the treatment was safe to use in breast cancer patients and women with reconstructed breasts, said Dr. Anthony Rossi, a fellow in procedural dermatology/Mohs surgery at Memorial Sloan-Kettering Cancer Center in New York.
Dr. Anthony Rossi
"After treatment, all patients reported improvement, including an improved sense of confidence and aesthetic appearance, and one patient commented that she was now able to change in front of her partner without embarrassment," said Dr. Rossi.
Chronic radiation dermatitis can occur within 1 or 2 years of treatment for breast cancer. In one study, 59% of women had telangectasias within 5 years of undergoing electron-beam radiotherapy, and 72% had telangectasias at the treatment site within 7 years (Br. J. Radiol. 2002;75:444-7).
The clinical characteristics include skin atrophy, hypo- or hyperpigmentation, and prominent lesions believed to be caused by dilation of reduced or poorly supported skin vasculature. Telangectasias of the breast are typically confined to the site of the highest radiation dose and to areas that received radiation boosts, such as surgical scars.
For women who have undergone breast cancer therapy, telangectasias "can serve as a reminder of their cancer, almost akin to a surgical scar, and can prompt fears of recurrence or even social anxiety," Dr. Rossi said.
He and his colleagues conducted a retrospective study of 11 patients treated with a pulsed-dye laser for radiation-induced telangectasias, looking at radiation type and dose received; onset, color, thickness, and distribution of telangectasias; laser fluence parameters; and complications. They also evaluated patient perceptions and quality of life, and had pre- and postlaser clinical photos assessed by two independent raters to judge percentage clearance of telangectasias.
The women had received an average of 5,000 cGy (50 Gy) in 25 fractions, often with radiation boosts to the surgical scars. The telangectasias developed a mean of 3.7 years after radiation exposure.
Five patients were treated with a 595-nm pulsed-dye laser, and two with a 585-nm laser. The endpoint for all treatments was transient purpura.
The mean clearance was 72.7% (range, 50%-90%), after a mean of 4.3 treatments (2-9). The average laser fluence used was 7.2 J/cm2. The energy was applied with a 10-mm spot size in 3- to 6-ms pulses.
The investigators saw no adverse effects of therapy, including in women with reconstructed breasts, whether with implants or flaps.
Based on their findings, the investigators are embarking on a prospective study designed to evaluate the effect of radiation-induced telangiectasias on patient quality of life and changes in quality of life measures after laser therapy, using the Skindex-16 and BREAST-Q validated scales. They also plan to assess long-term effects on quality of life and recurrence, if any, of treated telangectasias.
The study was internally funded. Dr. Rossi reported having no financial disclosures.