Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast

Harris, Jay R.; Levene, Martin B.; Svensson, Göran K.; Hellman, Samuel

doi:10.1016/0360-3016(79)90729-6

Cited by 666 publications

(348 citation statements)

References 10 publications

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“…It also confirmed breast size as a significant risk factor for change in photographic breast appearance, also consistent with a majority of published reports [2][3][4][5][6][7][8][9]. The effect of dose inhomogeneity on late adverse effects of 2D-planned breast radiotherapy has been tested in two randomised trials.…”

Section: Discussionsupporting

confidence: 86%

“…There is retrospective evidence that breast size is a risk factor for late adverse effects following breast conservation surgery and adjuvant radiotherapy for early breast cancer [1][2][3][4][5][6][7][8][9]. Body mass index, correlated to breast size and brassiere size, has also been linked to the risk of acute skin reactions and to late cosmesis [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Large breast size as a risk factor for late adverse effects of breast radiotherapy: Is residual dose inhomogeneity, despite 3D treatment planning and delivery, the main explanation?

Goldsmith

Haviland

Tsang

et al. 2011

Radiotherapy and Oncology

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a b s t r a c tBackground and Purpose: Large breast size is associated with an increased risk of late adverse effects after breast conservation surgery and radiotherapy, even when 3D dosimetry is used. The purpose of this study is to test the hypothesis that residual dose inhomogeneity is sufficient to explain the association. Methods: Patients previously treated after breast conservation surgery with whole breast radiotherapy using 3D dosimetry and followed up in the UK FAST hypofractionation trial were selected for this analysis. The residual level of dose inhomogeneity across the whole breast treatment volume was used to test for association between residual dosimetry and post-treatment change in breast appearance at 2 years post-radiotherapy. Results: At 2 years, 201/279 (72%) of women had no change in photographic breast appearance, 61 (22%) had mild change and 17 (6%) had marked change. Breast size and dosimetry were both significantly associated with late effects in univariate analyses, but only breast size remained an independent significant risk factor for change in breast appearance when included in a multiple regression model together with other prognostic factors (p = 0.006 for trend). Conclusion: Large-breasted women are more likely to suffer change in breast size and shape after whole breast radiotherapy delivered using 3D dosimetry, but residual dose inhomogeneity is insufficient to explain the association.Ó 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology xxx (2011) xxx-xxxThere is retrospective evidence that breast size is a risk factor for late adverse effects following breast conservation surgery and adjuvant radiotherapy for early breast cancer [1][2][3][4][5][6][7][8][9]. Body mass index, correlated to breast size and brassiere size, has also been linked to the risk of acute skin reactions and to late cosmesis [10][11][12]. Not all studies are confirmatory, but the weight of evidence suggests that the association between the size of the breast and the risk of early and late adverse effects in the breast is real [13][14][15][16]. Analyses are based on assessments of late adverse effects made in clinic or from photographs, focusing on changes in breast size and shape, breast oedema and telangiectasia. Marked acute skin reactions in the inframammary fold of heavy-breasted patients may explain part of the association via an increased risk of consequential late effects.Suboptimal dosimetry is thought to explain at least part of the association between breast size and risk of late normal tissue damage after radiotherapy delivered using 2D techniques [1,2,4,6,17]. A cause and effect relationship is supported by the 5-year results of a randomised trial (N = 306) comparing 2D and 3D radiation dosimetry [18], but not so far by the 2-year results of a larger confirmatory study [19]. Assuming dose distribution matters, it is not known if residual dose inhomogeneity in patients treated using 3D dosimetry explains a significant component of late adverse effects in large breasted w...

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Large breast size as a risk factor for late adverse effects of breast radiotherapy: Is residual dose inhomogeneity, despite 3D treatment planning and delivery, the main explanation?

Goldsmith

Haviland

Tsang

et al. 2011

Radiotherapy and Oncology

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“…Breast retraction has been reported to be the most disturbing cosmetic problem in the long run (134). The risk of a poor cosmetic result depends on the radiation dose delivered, and whole breast radiation doses of 60 Gy or more or skin doses above 50 Gy have both been related to a poor cosmetic result (132,135). Interstitial irradiation with small implants has no negative impact on the cosmetic result, while larger implantation volumes have been found to impair it (133).…”

Section: Cosmetic Results After Breast-conserving Therapymentioning

confidence: 99%

Treatment of Early Breast Cancer with Conservation of the Breast a Review

1991

Acta Oncologica

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This paper reviews the current status of conservative treatment for early breast cancer. While the first patients were treated with such techniques more than 60 years ago, it is during the last decade that randomized trials have confirmed that such treatment is comparable to mastectomy in preventing breast cancer death. Radiotherapy to the breast after local tumour excision is important to prevent local breast relapse, but it is not clear whether it has any influence on the risk of distant metastases. Several questions remain to be answered. While most investigators agree that the breast should receive a radiation dose of about 50Gy in 5 weeks, there is no general agreement about the need for a tumour bed booster dose. Considering patients with tumour infiltration at the surgical resection line for whom it is not possible for cosmetic reasons to perform re-resection, it is not clear whether an acceptable local control rate can be achieved through application of a high booster dose in the tumour bed. More trials are needed to show whether certain patients with small invasive carcinomas should be treated with wide local excision without radiotherapy. The need for radiotherapy after local excision for small intraductal (ductal carcinoma in situ) cancers is being addressed in ongoing trials.Key words: Breast cancer, breast conserving therapy, local relapse risk, review.The term 'breast-conserving treatment' includes techniques by which radical eradication of an early breast cancer (TI -2, NO-I, MO) is achieved without ablation of the mammary gland. Such treatment techniques have attracted widespread interest and recently become accepted alternatives to more radical and mutilating surgical procedures. The possibility of treating limited breast cancers, without breast ablation was suggested more than 60 years ago. Hirsch. (1) in Berlin and Keynes (2) in London published their first results in 1927 and 1929 respectively. Mustakallio (3) in Helsinki published his first series in 1945, and the Institute Curie group headed by Baclesse published their results in 1949 (4). The preliminary results achieved by these pioneers suggested that survival after breastconserving treatment could be similar to that achieved after radical mastectomy. This view gained further support when a follow-up paper from St. Bartholomew's Hospital (5) in 1953 reported long-term survival to be similar among the patients treated conservatively by Keynes and breast cancer patients treated in the same hospital with mastectomy. During the 1960s more authors reported encouraging results with breast-conserving treatment (6-9). and during the last two decades multiple reports have been published:1. The survival rate and risk of distant metastases following breastconserving therapy and mastectomy have been compared in randomized trials. 2.Long-term ( > 25 years) follow-up reports containing large numbers of patients have provided important information on long-term survival and risk of locoregional failure. These studies also give important informat...

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“…At a median follow-up of 122 months, the local recurrence rates were not significantly different in the two arms of the trial. The cosmetic results using Harvard criteria 43 were found to be favourable in the PBI arm. The rate for a cosmesis score of excellent to good was 81% for the PBI group and 63% for the WBI group (p =0.0015).…”

Section: Randomised Controlled Trials Of Partial Breast Irradiation Vmentioning

confidence: 96%

A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

Harris

Mukesh

Jena

et al. 2014

Efficacy and Mechanism Evaluation

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Background Whole-breast radiotherapy (WBRT) is the standard treatment for breast cancer following breast-conserving surgery. Evidence shows that tumour recurrences occur near the original cancer: the tumour bed. New treatment developments include increasing dose to the tumour bed during WBRT (synchronous integrated boost) and irradiating only the region around the tumour bed, for patients at high and low risk of tumour recurrence, respectively. Currently, standard imaging uses bony anatomy to ensure accurate delivery of WBRT. It is debatable whether or not more targeted treatments such as synchronous integrated boost and partial-breast radiotherapy require image-guided radiotherapy (IGRT) focusing on implanted tumour bed clips (clip-based IGRT). Objectives Primary – to compare accuracy of patient set-up using standard imaging compared with clip-based IGRT. Secondary – comparison of imaging techniques using (1) tumour bed radiotherapy safety margins, (2) volume of breast tissue irradiated around tumour bed, (3) estimated breast toxicity following development of a normal tissue control probability model and (4) time taken. Design Multicentre observational study embedded within a national randomised trial: IMPORT-HIGH (Intensity Modulated and Partial Organ Radiotherapy – HIGHer-risk patient group) testing synchronous integrated boost and using clip-based IGRT. Setting Five radiotherapy departments, participating in IMPORT-HIGH. Participants Two-hundred and eighteen patients receiving breast radiotherapy within IMPORT-HIGH. Interventions There was no direct intervention in patients’ treatment. Experimental and control intervention were clip-based IGRT and standard imaging, respectively. IMPORT-HIGH patients received clip-based IGRT as routine; standard imaging data were obtained from clip-based IGRT images. Main outcome measures Difference in (1) set-up errors, (2) safety margins, (3) volume of breast tissue irradiated, (4) breast toxicity and (5) time, between clip-based IGRT and standard imaging. Results The primary outcome of overall mean difference in clip-based IGRT and standard imaging using daily set-up errors was 2–2.6 mm (p < 0.001). Heterogeneity testing between centres found a statistically significant difference in set-up errors at one centre. For four centres (179 patients), clip-based IGRT gave a mean decrease in the systematic set-up error of between 1 mm and 2 mm compared with standard imaging. Secondary outcomes were as follows: clip-based IGRT and standard imaging safety margins were less than 5 mm and 8 mm, respectively. Using clip-based IGRT, the median volume of tissue receiving 95% of prescribed boost dose decreased by 29 cm3 (range 11–193 cm3) compared with standard imaging. Difference in median time required to perform clip-based IGRT compared with standard imaging was X-ray imaging technique dependent (range 8–76 seconds). It was not possible to estimate differences in breast toxicity, the normal tissue control probability model indicated that for breast fibrosis maximum radiotherapy dose is ...

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Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast

Cited by 666 publications

References 10 publications

Large breast size as a risk factor for late adverse effects of breast radiotherapy: Is residual dose inhomogeneity, despite 3D treatment planning and delivery, the main explanation?

Large breast size as a risk factor for late adverse effects of breast radiotherapy: Is residual dose inhomogeneity, despite 3D treatment planning and delivery, the main explanation?

Treatment of Early Breast Cancer with Conservation of the Breast a Review

A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

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