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Cosmetic changes following surgery and accelerated partial breast irradiation using HDR interstitial brachytherapy

Evaluation by a multidisciplinary/multigender committee

Kosmetische Veränderungen nach Operation und akzellerierter Teilbrustbestrahlung mittels HDR-interstitieller Brachytherapie

Auswertung durch einen multidisziplinären Multigender-Ausschuss

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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.

Zusammenfassung

Einleitung

Brustkrebspatientinnen im Frühstadium können nach einer brusterhaltenden Operation (BCS) von einer adjuvanten akzelerierten Teilbrustbestrahlung (APBI) profitieren. Die vorliegende Arbeit berichtet über die kosmetischen Ergebnisse nach APBI mittels HDR-interstitieller Brachytherapie (HDR-IBT) in Multikatheter-Technik.

Methoden

Zwischen2006 und 2014 hatten 114 Patientinnen eine adjuvante APBI mittels Mulitkatheter-HDR-IBT erhalten. Von jeder Patientin wurden 2 Fotografien analysiert: die erste wurde nach der Operation, aber vor Implantation der Brachytherapiekatheter (Basisbild) aufgenommen, die zweite bei der letzten Nachuntersuchung. Die kosmetische Bewertung wurde durch ein multidisziplinäres Multigender-Team anhand der „Harvard-Breast-Cosmesis“-Skala bewertet. Dosis-Volumen-Histogramm-(DVH-)Parameter und die beobachteten kosmetischen Veränderungen wurden auf mögliche Korrelationen untersucht.

Ergebnisse

Die mediane Nachbeobachtungszeit betrug 3,5 Jahre (Spanne 0,6–8,5 Jahre). Die endgültige kosmetische Bewertung war bei 30 % ausgezeichnet, bei 52 % gut, bei 14,5 % fair und bei 3,5 % schlecht. Ein Vergleich der Basis- und Nachsorge-Bilder ergab bei 59,6% keine Veränderung, bei 36% ein besseres und bei 4,4 % ein schlechteres Ergebnis. Nur niedrigere ‚‚Dose-non-uniformity-ratio‛‛-(DNR-)Werte (0,3 vs. 0,26; p = 0,009) waren signifikant mit einem verbesserten kosmetischen Ergebnis assoziiert.

Schlussfolgerung

APBI mittels HDR-IBT ergibt ein günstiges endgültiges kosmetisches Ergebnis. Eine Verschlechterung der Kosmetik der Brust tritt bei weniger als 5 % der Patientinnen ein. Die endgültigen kosmetischen Ergebnisse bei mit BCS und HDR-IBT behandelten Patientinnen werden vor allem durch das kosmetische Ergebnis der Operation beeinflusst.

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Authors and Affiliations

  1. Interdisciplinary Brachytherapy Unit, University of Luebeck/UKSH-CL, Ratzeburger Allee 160, 23538, Luebeck, Germany

    Tamer Soror, György Kovács, Nina Seibold & Corinna Melchert

  2. National Cancer Institute (NCI), Radiation Oncology Department, Cairo University, Cairo, Egypt

    Tamer Soror

  3. Clinic for Gynecology and Obstetrics, University of Luebeck/UKSH-CL, Luebeck, Germany

    Kristin Baumann

  4. Clinic for Plastic Surgery, University of Luebeck/UKSH-CL, Luebeck, Germany

    Eike Wenzel

  5. Institute for Oncology and Radiology (IORS), Medical School University of Belgrade, Belgrade, Serbia

    Suzana Stojanovic-Rundic

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  1. Tamer Soror
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Correspondence to Tamer Soror.

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Conflict of interest

T. Soror, G. Kovács, N. Seibold, C. Melchert, K. Baumann, E. Wenzel, and S. Stojanovic-Rundic declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. Consent was obtained from all patients identifiable from images or other information within the manuscript. In the case of underage patients, consent was obtained from a parent or legal guardian.

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Soror, T., Kovács, G., Seibold, N. et al. Cosmetic changes following surgery and accelerated partial breast irradiation using HDR interstitial brachytherapy. Strahlenther Onkol 193, 367–374 (2017). https://doi.org/10.1007/s00066-016-1093-6

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  • DOI: https://doi.org/10.1007/s00066-016-1093-6

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