Factors Associated With Optimal Long-Term Cosmetic Results in Patients Treated With Accelerated Partial Breast Irradiation Using Balloon-Based Brachytherapy

• Published in: International journal of radiation oncology, biology, physics Vol. 83; no. 2; pp. 512 - 518
• Main Authors: Vicini, Frank A., M.D, Keisch, Martin, M.D, Shah, Chirag, M.D, Goyal, Sharad, M.D, Khan, Atif J., M.D, Beitsch, Peter D., M.D, Lyden, Maureen, M.S, Haffty, Bruce G., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2012; Elsevier
• Subjects: Accelerated partial breast irradiation; Adult; Aged; Aged, 80 and over; BALLOONS; Biological and medical sciences; BRACHYTHERAPY; Brachytherapy - instrumentation; Brachytherapy - methods; Breast - pathology; Breast - radiation effects; Breast - surgery; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Combined Modality Therapy - methods; Cosmesis; Dose Fractionation; Esthetics; Female; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Hematology, Oncology and Palliative Medicine; Humans; IRRADIATION; Mammary gland diseases; MAMMARY GLANDS; MammoSite; Mastectomy, Segmental; Medical sciences; Middle Aged; Multivariate Analysis; NEOPLASMS; PATIENTS; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Registries; REGRESSION ANALYSIS; SKIN; Time Factors; Treatment Outcome; Tumor Burden; Tumors; Accelerated partial breast irradiation; MammoSite; Cosmesis; Brachytherapy; Breast cancer; Cosmetic; Human; Breast disease; Malignant tumor; Radiotherapy; Long term; Mammary gland diseases; Cancerology; Treatment; Partial; Sounding balloon; Irradiation; Breast; Mammary gland; Curietherapy; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2011.07.011

Purpose To evaluate factors associated with optimal cosmetic results at 72 months for early-stage breast cancer patients treated with Mammosite balloon-based accelerated partial breast irradiation (APBI). Methods and Materials A total of 1,440 patients (1,449 cases) with early-stage breast cancer undergoing breast-conserving therapy were treated with balloon-based brachytherapy to deliver APBI (34 Gy in 3.4-Gy fractions). Cosmetic outcome was evaluated at each follow-up visit and dichotomized as excellent/good (E/G) or fair/poor (F/P). Follow-up was evaluated at 36 and 72 months to establish long-term cosmesis, stability of cosmesis, and factors associated with optimal results. Results The percentage of evaluable patients with excellent/good (E/G) cosmetic results at 36 months and more than 72 months were 93.3% ( n = 708/759) and 90.4% ( n = 235/260). Factors associated with optimal cosmetic results at 72 months included: larger skin spacing ( p = 0.04) and T1 tumors ( p = 0.02). Using multiple regression analysis, the only factors predictive of worse cosmetic outcome at 72 months were smaller skin spacing (odds ratio [OR], 0.89; confidence interval [CI], 0.80–0.99) and tumors greater than 2 cm (OR, 4.96, CI, 1.53–16.07). In all, 227 patients had both a 36-month and a 72-month cosmetic evaluation. The number of patients with E/G cosmetic results decreased only slightly from 93.4% at 3 years to 90.8% ( p = 0.13) at 6 years, respectively. Conclusions APBI delivered with balloon-based brachytherapy produced E/G cosmetic results in 90.4% of cases at 6 years. Larger tumors (T2) and smaller skin spacing were found to be the two most important independent predictors of cosmesis.