Tabassum Wadasadawala1, Shwetabh Sinha2, Vani Parmar3, Shalini Verma2, Mithila Gaikar4, Sadhana Kannan5, Monidipa Mondal2, Rima Pathak2, Urvashi Jain3, Rajiv Sarin6. 1. Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, 410210, India. twadasadawala@actrec.gov.in. 2. Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India. 3. Department of Surgical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, India. 4. Clinical Research Secretariat, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India. 5. Department of Biostatistics, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, India. 6. Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, 410210, India.
Abstract
BACKGROUND: To compare the early cosmetic outcomes after whole breast radiotherapy (WBRT) and accelerated partial breast irradiation (APBI) by various cosmetic assessment methods. MATERIALS/ METHODS: APBI was delivered using multiplane interstitial brachytherapy as per standard guidelines. Majority of women in WBRT cohort received hypo-fractionated external beam radiotherapy using bitangential portals and mega-voltage photons along with sequential boost to the tumor bed. Single cross-sectional assessment (18-36 months post-treatment completion) of the breast cosmesis was done by RO, SO and the patient using the modified Harvard scale and by photographic assessment using the BCCT.core software. The two cohorts were propensity score-matched using menopausal status, size of surgical cavity, size of tumor in greatest dimension, median number of lymph nodes dissected, treatment with adjuvant chemotherapy and treatment with hormonal therapy. RESULTS: A total of 64 APBI patients were matched with 99 WBRT patients of the entire cohort of 320. At a median follow-up of 25 months, cosmetic results were significantly better for APBI as compared to WBRT cohort by all methods of evaluation (excellent/good: RO:75% vs 38.4%, p = 0.0001; SO: 54.7% vs 37.4%, p = 0.009; patient: 87.5% vs 58.6%, p = 0.001 and BCCT: 73.4% vs 51.6%, p = 0.001). Individual parameters that were significantly better in APBI cohort included size and shape of breast as well as location and shape of NAC. Better results for individual BCCT parameters (pLBC, pBRE, pBAD) were also seen. CONCLUSIONS: Overall cosmetic outcomes as well as individual subdomains are significantly better with APBI as compared to WBRT by all methods of assessment of cosmesis when matched for various factors.
BACKGROUND: To compare the early cosmetic outcomes after whole breast radiotherapy (WBRT) and accelerated partial breast irradiation (APBI) by various cosmetic assessment methods. MATERIALS/ METHODS: APBI was delivered using multiplane interstitial brachytherapy as per standard guidelines. Majority of women in WBRT cohort received hypo-fractionated external beam radiotherapy using bitangential portals and mega-voltage photons along with sequential boost to the tumor bed. Single cross-sectional assessment (18-36 months post-treatment completion) of the breast cosmesis was done by RO, SO and the patient using the modified Harvard scale and by photographic assessment using the BCCT.core software. The two cohorts were propensity score-matched using menopausal status, size of surgical cavity, size of tumor in greatest dimension, median number of lymph nodes dissected, treatment with adjuvant chemotherapy and treatment with hormonal therapy. RESULTS: A total of 64 APBI patients were matched with 99 WBRT patients of the entire cohort of 320. At a median follow-up of 25 months, cosmetic results were significantly better for APBI as compared to WBRT cohort by all methods of evaluation (excellent/good: RO:75% vs 38.4%, p = 0.0001; SO: 54.7% vs 37.4%, p = 0.009; patient: 87.5% vs 58.6%, p = 0.001 and BCCT: 73.4% vs 51.6%, p = 0.001). Individual parameters that were significantly better in APBI cohort included size and shape of breast as well as location and shape of NAC. Better results for individual BCCT parameters (pLBC, pBRE, pBAD) were also seen. CONCLUSIONS: Overall cosmetic outcomes as well as individual subdomains are significantly better with APBI as compared to WBRT by all methods of assessment of cosmesis when matched for various factors.
Entities:
Keywords:
APBI; Brachytherapy; Cosmesis; Late toxicity