How would you approach a non-healing wound following lumpectomy for recurrent disease in a patient who underwent breast conservation therapy with radiation 10 years prior?  

The patient had lumpectomy with standard radiotherapy to 50 Gy whole breast, followed by 10 Gy boost 11 years ago, and was recently found to have a small focus of low-grade DCIS on follow-up mammogram, treated with lumpectomy.

The patient developed erythema on the skin surrounding the wound from her lumpectomy, which is not healing, but draining serous, non-purulent discharge. She is on oral and IV antibiotics without significant improvement, with negative bacterial cultures.

A surgeon claims that this is not an infection but a late complication of radiotherapy, precipitated by the recent surgery, and that the patient should be treated with steroids. I should add that this surgeon is not the one who did the surgery and also has been a breast cancer surgeon for 30+ years. 



Answer from: Radiation Oncologist at Community Practice