Impact of the Radiation Boost on Outcomes After Breast-Conserving Surgery and Radiation
- Temple University School of Medicine, Philadelphia, PA (United States)
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA (United States)
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)
Purpose: We examined the impact of radiation tumor bed boost parameters in early-stage breast cancer on local control and cosmetic outcomes. Methods and Materials: A total of 3,186 women underwent postlumpectomy whole-breast radiation with a tumor bed boost for Tis to T2 breast cancer from 1970 to 2008. Boost parameters analyzed included size, energy, dose, and technique. Endpoints were local control, cosmesis, and fibrosis. The Kaplan-Meier method was used to estimate actuarial incidence, and a Cox proportional hazard model was used to determine independent predictors of outcomes on multivariate analysis (MVA). The median follow-up was 78 months (range, 1-305 months). Results: The crude cosmetic results were excellent in 54%, good in 41%, and fair/poor in 5% of patients. The 10-year estimate of an excellent cosmesis was 66%. On MVA, independent predictors for excellent cosmesis were use of electron boost, lower electron energy, adjuvant systemic therapy, and whole-breast IMRT. Fibrosis was reported in 8.4% of patients. The actuarial incidence of fibrosis was 11% at 5 years and 17% at 10 years. On MVA, independent predictors of fibrosis were larger cup size and higher boost energy. The 10-year actuarial local failure was 6.3%. There was no significant difference in local control by boost method, cut-out size, dose, or energy. Conclusions: Likelihood of excellent cosmesis or fibrosis are associated with boost technique, electron energy, and cup size. However, because of high local control and rare incidence of fair/poor cosmesis with a boost, the anatomy of the patient and tumor cavity should ultimately determine the necessary boost parameters.
- OSTI ID:
- 21587693
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 81, Issue 1; Other Information: DOI: 10.1016/j.ijrobp.2010.04.067; PII: S0360-3016(10)00683-8; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
Similar Records
Decline of Cosmetic Outcomes Following Accelerated Partial Breast Irradiation Using Intensity Modulated Radiation Therapy: Results of a Single-Institution Prospective Clinical Trial
High-Dose-Rate Brachytherapy Boost Effect on Local Tumor Control in Young Women With Breast Cancer