Predictors of poor cosmesis in breast cancer patients treated with adjuvant whole breast radiation therapy plus high-dose-rate interstitial brachytherapy boost after breast conservation surgery

Nasim Feizi; Shole Arvandi; Maryam Feli; Fatemeh Mohammadian; Ziba Zahiri; Azin Shamsi; Ali Bagheri

doi:10.5114/jcb.2022.121403

Predictors of poor cosmesis in breast cancer patients treated with adjuvant whole breast radiation therapy plus high-dose-rate interstitial brachytherapy boost after breast conservation surgery

J Contemp Brachytherapy. 2022 Oct;14(5):429-437. doi: 10.5114/jcb.2022.121403. Epub 2022 Nov 21.

Authors

Nasim Feizi¹, Shole Arvandi¹, Maryam Feli², Fatemeh Mohammadian², Ziba Zahiri¹, Azin Shamsi¹, Ali Bagheri²

Affiliations

¹ Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
² Interventional Radiotherapy Ward, Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Abstract

Purpose: To identify patient, tumor, and treatment-related factors, which predict cosmesis in breast cancer survivors treated with adjuvant whole breast irradiation (WBI) plus high-dose-rate (HDR) multicatheter interstitial brachytherapy (MIBT) boost after breast conservation surgery.

Material and methods: At least 12 months after completion of radiotherapy, cosmetic outcomes were measured both objectively with BCCT.core software (using a front view digital photograph), and subjectively according to Harvard's criteria. MIBT dose fractionation regimen was 13.6 Gy/4 fractions (bid). To evaluate the correlation between cosmetic scores and dose-volume histogram (DVH) parameters, WBI and MIBT plans were retrospectively analyzed, and ipsilateral skin and breast biologically equivalent dosimetric indices were recorded (α/β = 3 Gy). A multivariate ordinal logistic regression model was used for statistical analysis.

Results: Twenty-eight consecutive patients were enrolled into this study. The median time from completion of radiation therapy to cosmesis scoring was 18 months. In evaluation with BCCT.core software, no patient was scored as excellent. Cosmesis was good in 18%, fair in 50%, and poor in 32% of patients. According to Harvard's scale, 10.5% of patients had excellent cosmesis, and 43%, 28.5%, and 18% of patients had good, fair, and poor scores, respectively. In univariate analysis, patients with higher absolute MIBT V_29Gy (cc), those treated with irradiation of regional lymphatics (odds ratio ≈ 5), and patients with larger breast volumes had statistically significant lower Harvard's scores. In the multivariate model, none of the mentioned factors remained statistically significant, except for a trend for poorer cosmesis in patients with higher absolute MIBT V_29Gy (p-value = 0.066).

Conclusions: Based on the results of this study, MIBT breast V_29Gy, regional nodal irradiation, and larger breast volumes are the potential factors, which could predict cosmesis.

Keywords: boost; brachytherapy; breast cancer; cosmetic outcome; radiation therapy.