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Title: A cosmetic evaluation of breast cancer treatment: A randomized study of radiotherapy boost technique

Abstract

Purpose: To compare cosmetic results of two different radiotherapy (RT) boost techniques used in the treatment of breast cancer after whole breast radiotherapy and to identify factors affecting cosmetic outcomes. Methods and Materials: Between 1996 and 1998, 142 patients with Stage I and II breast cancer were treated with breast conservative surgery and adjuvant RT. Patients were then randomly assigned to receive a boost dose of 15 Gy delivered to the tumor bed either by iridium 192, or a combination of photons and electrons. Cosmetic evaluations were done on a 6-month basis, with a final evaluation at 36 months after RT. The evaluations were done using a panel of global and specific subjective scores, a digitized scoring system using the breast retraction assessment (BRA) measurement, and a patient's self-assessment evaluation. As cosmetic results were graded according to severity, the comparison of boost techniques was done using the ordinal logistic regression model. Adjusted odds ratios (OR) and their 95% confidence intervals (CI) are presented. Results: At 36 months of follow-up, there was no significant difference between the two groups with respect to the global subjective cosmetic outcome (OR = 1.40; 95%CI = 0.69-2.85, p = 0.35). Good to excellent scores weremore » observed in 65% of implant patients and 62% of photon/electron patients. At 24 months and beyond, telangiectasia was more severe in the implant group with an OR of 9.64 (95%CI = 4.05-22.92, p < 0.0001) at 36 months. The only variable associated with a worse global cosmetic outcome was the presence of concomitant chemotherapy (OR = 3.87; 95%CI = 1.74-8.62). The BRA value once adjusted for age, concomitant chemotherapy, and boost volume showed a positive association with the boost technique. The BRA value was significantly greater in the implant group (p 0.03). There was no difference in the patient's final self-assessment score between the two groups. Three variables were statistically associated with an adverse self-evaluation: an inferior quadrant tumor localization, postoperative hematoma, and concomitant chemotherapy. Conclusions: Although this trial showed that at 36 months of follow-up, there were no significant differences in the overall global cosmetic scores between the implant boost group and the photon/electron boost group, telangiectasia was more severe and the BRA value was greater in the implant group.« less

Authors:
 [1];  [2]
  1. Department of Radio-oncology, Complexe Hospitalier de la Sagamie, Chicoutimi, Quebec (Canada) and Laval University, Quebec City, Quebec (Canada). E-mail: sylvie.vass@ssss.gouv.qc.ca
  2. Department of Surgery, Faculty of Medecine, Laval University, Quebec City, Quebec (Canada) and Laval University Cancer Research Center, Laval University, Quebec City, Quebec (Canada)
Publication Date:
OSTI Identifier:
20698480
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 62; Journal Issue: 5; Other Information: DOI: 10.1016/j.ijrobp.2004.12.039; PII: S0360-3016(04)03157-8; Copyright (c) 2005 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; CHEMOTHERAPY; HEMATOMAS; IMPLANTS; IRIDIUM 192; MAMMARY GLANDS; PATIENTS; RADIATION SOURCE IMPLANTS; RADIOTHERAPY; SURGERY

Citation Formats

Vass, Sylvie, and Bairati, Isabelle. A cosmetic evaluation of breast cancer treatment: A randomized study of radiotherapy boost technique. United States: N. p., 2005. Web. doi:10.1016/j.ijrobp.2004.12.039.
Vass, Sylvie, & Bairati, Isabelle. A cosmetic evaluation of breast cancer treatment: A randomized study of radiotherapy boost technique. United States. doi:10.1016/j.ijrobp.2004.12.039.
Vass, Sylvie, and Bairati, Isabelle. Mon . "A cosmetic evaluation of breast cancer treatment: A randomized study of radiotherapy boost technique". United States. doi:10.1016/j.ijrobp.2004.12.039.
@article{osti_20698480,
title = {A cosmetic evaluation of breast cancer treatment: A randomized study of radiotherapy boost technique},
author = {Vass, Sylvie and Bairati, Isabelle},
abstractNote = {Purpose: To compare cosmetic results of two different radiotherapy (RT) boost techniques used in the treatment of breast cancer after whole breast radiotherapy and to identify factors affecting cosmetic outcomes. Methods and Materials: Between 1996 and 1998, 142 patients with Stage I and II breast cancer were treated with breast conservative surgery and adjuvant RT. Patients were then randomly assigned to receive a boost dose of 15 Gy delivered to the tumor bed either by iridium 192, or a combination of photons and electrons. Cosmetic evaluations were done on a 6-month basis, with a final evaluation at 36 months after RT. The evaluations were done using a panel of global and specific subjective scores, a digitized scoring system using the breast retraction assessment (BRA) measurement, and a patient's self-assessment evaluation. As cosmetic results were graded according to severity, the comparison of boost techniques was done using the ordinal logistic regression model. Adjusted odds ratios (OR) and their 95% confidence intervals (CI) are presented. Results: At 36 months of follow-up, there was no significant difference between the two groups with respect to the global subjective cosmetic outcome (OR = 1.40; 95%CI = 0.69-2.85, p = 0.35). Good to excellent scores were observed in 65% of implant patients and 62% of photon/electron patients. At 24 months and beyond, telangiectasia was more severe in the implant group with an OR of 9.64 (95%CI = 4.05-22.92, p < 0.0001) at 36 months. The only variable associated with a worse global cosmetic outcome was the presence of concomitant chemotherapy (OR = 3.87; 95%CI = 1.74-8.62). The BRA value once adjusted for age, concomitant chemotherapy, and boost volume showed a positive association with the boost technique. The BRA value was significantly greater in the implant group (p 0.03). There was no difference in the patient's final self-assessment score between the two groups. Three variables were statistically associated with an adverse self-evaluation: an inferior quadrant tumor localization, postoperative hematoma, and concomitant chemotherapy. Conclusions: Although this trial showed that at 36 months of follow-up, there were no significant differences in the overall global cosmetic scores between the implant boost group and the photon/electron boost group, telangiectasia was more severe and the BRA value was greater in the implant group.},
doi = {10.1016/j.ijrobp.2004.12.039},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 5,
volume = 62,
place = {United States},
year = {Mon Aug 01 00:00:00 EDT 2005},
month = {Mon Aug 01 00:00:00 EDT 2005}
}