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Title: Predictors of Adverse Cosmetic Outcome in the RAPID Trial: An Exploratory Analysis

Purpose: To evaluate factors associated with adverse cosmesis outcome in breast cancer patients randomized to accelerated partial breast irradiation (APBI) using 3-dimensional conformal radiation therapy or whole-breast irradiation in the RAPID (Randomized Trial of Accelerated Partial Breast Irradiation) trial. Methods and Materials: Subjects were trial participants with nurse-assessed global cosmetic scores at baseline and at 3 years. Adverse cosmesis was defined as a score of fair or poor. Cosmetic deterioration was defined as any adverse change in score from baseline to 3 years. The analysis is based on data from the previously reported interim analysis. Logistic regression models were used to assess the association of risk factors for these outcomes among all patients and those treated with APBI only. Results: Clinicopathologic characteristics were similar between subjects randomized to APBI (n=569) or whole-breast irradiation (n=539). For all subjects, factors associated with adverse cosmesis at 3 years were older age, central/inner tumor location, breast infection, smoking, seroma volume, breast volume, and use of APBI; factors associated with cosmetic deterioration were smoking, seroma volume, and use of APBI (P<.05). For APBI subjects, tumor location, smoking, age, and seroma volume were associated with adverse cosmesis (P<.05), and smoking was associated with cosmetic deterioration (P=.02). An independent association betweenmore » the V95/whole-breast volume ratio and adverse cosmesis (P=.28) or cosmetic deterioration (P=.07) was not detected. On further exploration a V95/whole-breast volume ratio <0.15 was associated with a lower risk of cosmetic deterioration (p=.04), but this accounted for only 11% of patients. Conclusion: In the RAPID trial, a number of patient tumor and treatment-related factors, including the use of APBI, were associated with adverse cosmesis and cosmetic deterioration. For patients treated with APBI alone, the high-dose treatment volume was not independently associated with an adverse cosmetic outcome, and a useful clinical threshold could not be identified.« less
;  [1] ;  [2] ;  [3] ;  [1] ; ;  [4] ;  [5] ;  [6] ;  [7] ;  [8] ;  [9] ;  [10] ;  [3] ;  [11] ;  [12] ;  [13] ;  [4] ;
  1. Vancouver Island Centre, British Columbia Cancer Agency, Victoria, British Columbia (Canada)
  2. Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario (Canada)
  3. Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta (Canada)
  4. Juravinski Cancer Centre at Hamilton Health Sciences, McMaster University, Hamilton, Ontario (Canada)
  5. Centre Hospitalier Universitaire de Québec, Pavillon Hôtel-Dieu de Quebec, Quebec City, Québec (Canada)
  6. Vancouver Centre, British Columbia Cancer Agency, Vancouver, British Columbia (Canada)
  7. CancerCare Manitoba, Winnipeg, Manitoba (Canada)
  8. Centre intégré de cancérologie de Laval, Laval, Québec (Canada)
  9. Center for the Southern Interior, British Columbia Cancer Agency, Kelowna, British Columbia (Canada)
  10. University Health Network, Princess Margaret Hospital, Toronto, Ontario (Canada)
  11. London Regional Cancer Centre, London, Ontario (Canada)
  12. Fraser Valley Centre, British Columbia Cancer Agency, Surrey, British Columbia (Canada)
  13. Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Québec (Canada)
Publication Date:
OSTI Identifier:
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 91; Journal Issue: 5; Other Information: Copyright (c) 2015 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States