Cosmetic changes following surgery and accelerated partial breast irradiation using HDR interstitial brachytherapy : Evaluation by a multidisciplinary/multigender committee

Strahlenther Onkol. 2017 May;193(5):367-374. doi: 10.1007/s00066-016-1093-6. Epub 2017 Jan 2.

Abstract

Background: Patients with early-stage breast cancer can benefit from adjuvant accelerated partial breast irradiation (APBI) following breast-conserving surgery (BCS). This work reports on cosmetic results following APBI using multicatheter high-dose-rate interstitial brachytherapy (HDR-IBT).

Patients and methods: Between 2006 and 2014, 114 patients received adjuvant APBI using multicatheter HDR-IBT. For each patient, two photographs were analyzed: the first was taken after surgery (baseline image) and the second at the last follow-up visit. Cosmesis was assessed by a multigender multidisciplinary team using the Harvard Breast Cosmesis Scale. Dose-volume histogram (DVH) parameters and the observed cosmetic results were investigated for potential correlations.

Results: The median follow-up period was 3.5 years (range 0.6-8.5 years). The final cosmetic scores were 30% excellent, 52% good, 14.5% fair, and 3.5% poor. Comparing the baseline and follow-up photographs, 59.6% of patients had the same score, 36% had a better final score, and 4.4% had a worse final score. Only lower target dose nonuniformity ratio (DNR) values (0.3 vs. 0.26; p = 0.009) were significantly associated with improved cosmetic outcome vs. same/worse cosmesis.

Conclusion: APBI using multicatheter HDR-IBT adjuvant to BCS results in favorable final cosmesis. Deterioration in breast cosmesis occurs in less than 5% of patients. The final breast cosmetic outcome in patients treated with BCS and APBI using multicatheter HDR-IBT is influenced primarily by the cosmetic result of the surgery. A lower DNR value is significantly associated with a better cosmetic outcome.

Keywords: Breast cancer; Breast-conserving surgery; Photographs; Survival; Toxicity.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brachytherapy / methods*
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / therapy*
  • Combined Modality Therapy / methods
  • Cosmetic Techniques*
  • Dose Fractionation, Radiation
  • Female
  • Humans
  • Male
  • Mastectomy, Segmental / methods*
  • Middle Aged
  • Observer Variation
  • Organ Sparing Treatments / methods*
  • Treatment Outcome