Factors influencing cosmetic results after breast conserving management (Turkish experience)

Çetintaş, Sibel Kahraman; Özkan, Lütfi; Kurt, Meral; Saran, A.; Taşdelen, İsmet; Tolunay, Şahsine; Topal, Uğur; Engin, K.

doi:10.1054/brst.2001.0372

Cited by 21 publications

(19 citation statements)

References 29 publications

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“…Patient ratings as “excellent” or “good” were reported by Johansen et al in 73%, by Taylor et al in 87%, and by Cetintas et al in 84%. Sneeuw et al reported a rate of “very satisfied” in 59% and “little satisfied” in 30% [5, 9, 11, 21]. …”

Section: Discussionmentioning

confidence: 99%

Determinants for patient satisfaction regarding aesthetic outcome and skin sensitivity after breast-conserving surgery

et al. 2016

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BackgroundWith the development of new surgical techniques in breast cancer, such as oncoplastic breast surgery, increased knowledge of risk factors for poor satisfaction with conventional breast-conserving surgery (BCS) is needed in order to determine which patients to offer these techniques to. The aim of this study was to investigate patient satisfaction regarding aesthetic result and skin sensitivity in relation to patient, tumour, and treatment factors, in a consecutive sample of patients undergoing conventional BCS.MethodsWomen eligible for BCS were recruited between February 1, 2008 and January 31, 2012 in a prospective setup. In all, 297 women completed a study-specific questionnaire 1 year after conventional BCS and radiotherapy. Potential risk factors for poor satisfaction were investigated using logistic regression analysis.ResultsThe great majority of the women, 84%, were satisfied or very satisfied with the overall aesthetic result. The rate of satisfaction regarding symmetry between the breasts was 68% and for skin sensitivity in the operated breast it was 67%. Excision of more than 20% of the preoperative breast volume was associated with poor satisfaction regarding overall aesthetic outcome, as was axillary clearance. A high BMI (≥30 kg/m2) seemed to affect satisfaction with symmetry negatively. Factors associated with less satisfied patients regarding skin sensitivity in the operated breast were an excision of ≥20% of preoperative breast volume, a BMI of 25–30 kg/m2, axillary clearance, and radiotherapy. Re-excision and postoperative infection were associated with lower rates of satisfaction regarding both overall aesthetic outcome and symmetry, as well as with skin sensitivity.ConclusionsSeveral factors affect patient satisfaction after BCS. A major determinant of poor satisfaction in this study was a large excision of breast volume. If the percentage of breast volume excised is estimated to exceed 20%, other techniques, such as oncoplastic breast surgery, with or without contralateral surgery, or mastectomy with reconstruction, may be considered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-016-1053-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Determinants for patient satisfaction regarding aesthetic outcome and skin sensitivity after breast-conserving surgery

et al. 2016

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“…Although standard radiation therapy is well tolerated by the majority of patients, late normal tissue complications arising from the intrinsic sensitivity of normal tissue, and correlated poor cosmetic results, remain as health concerns of treated breast cancer patients over time (Cetintas et al, 2002;Deutsch and Flickinger, 2003;Smith and Ross, 2004). The process of endothelium reconstruction is radiation dose-dependent, progresses over months and years and leads to increases in the severity of both telangiectasia and fibrosis (Bentzen et al, 1989;Archambeau et al, 1995;Chen et al, 2006).…”

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Genetic polymorphisms in DNA repair and damage response genes and late normal tissue complications of radiotherapy for breast cancer

et al. 2009

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Breast-conserving surgery followed by radiotherapy is effective in reducing recurrence; however, telangiectasia and fibrosis can occur as late skin side effects. As radiotherapy acts through producing DNA damage, we investigated whether genetic variation in DNA repair and damage response confers increased susceptibility to develop late normal skin complications. Breast cancer patients who received radiotherapy after breast-conserving surgery were examined for late complications of radiotherapy after a median follow-up time of 51 months. Polymorphisms in genes involved in DNA repair (APEX1, XRCC1, XRCC2, XRCC3, XPD) and damage response (TP53, P21) were determined. Associations between telangiectasia and genotypes were assessed among 409 patients, using multivariate logistic regression. A total of 131 patients presented with telangiectasia and 28 patients with fibrosis. Patients with variant TP53 genotypes either for the Arg72Pro or the PIN3 polymorphism were at increased risk of telangiectasia. The odds ratios (OR) were 1.66 (95% confidence interval (CI): 1.02 -2.72) for 72Pro carriers and 1.95 (95% CI: 1.13 -3.35) for PIN3 A2 allele carriers compared with non-carriers. The TP53 haplotype containing both variant alleles was associated with almost a two-fold increase in risk (OR 1.97, 95% CI: 1.11 -3.52) for telangiectasia. Variants in the TP53 gene may therefore modify the risk of late skin toxicity after radiotherapy.

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“…2,3 Because of the differences in physiological response of various skin layers to radiation, telangiectasia and subcutaneous fibrosis are among the most common long-term skin side effects of radiation therapy, with higher grade correlated with poor cosmesis. 4 The process of endothelium reconstruction is radiation dosedependent, progresses over months and years and leads to the increase in severity of both telangiectasia and fibrosis.5-7 Besides duration, radiation dose and schedule, 8,9 and other factors such as radiation fields, type of surgery, increased breast size, tamoxifen treatment, chemotherapy, acute skin reactions, age, race and smoking 3,7,8,[10][11][12][13] have been found to be associated with the development of these late skin toxicities.We and others have suggested that the interindividual differences in clinical radiosensitivity are likely the effect of both genetic and nongenetic factors, and that, in addition to rare ATM gene mutations, single nucleotide polymorphisms (SNPs) in key genes are likely to play a role in treatment outcomes. 8,[14][15][16][17][18] Intrinsic oxidative stress created during radiotherapy is likely to play a role in the development of late skin fibrosis, 19 as increased reactive oxygen species (ROS) production may affect vascular homeostasis.…”

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Genetic predictors of long‐term toxicities after radiation therapy for breast cancer

Kuptsova

Chang‐Claude

Kropp

et al. 2007

Intl Journal of Cancer

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Telangiectasia and subcutaneous fibrosis are the most common late dermatologic side effects observed in response to radiation treatment. Radiotherapy acts on cancer cells largely due to the generation of reactive oxygen species (ROS). ROS also induce normal tissue toxicities. Therefore, we investigated if genetic variation in oxidative stress-related enzymes confers increased susceptibility to late skin complications. Women who received radiotherapy following lumpectomy for breast cancer were followed prospectively for late tissue side effects after initial treatment. Final analysis included 390 patients. Polymorphisms in genes involved in oxidative stress-related mechanisms (GSTA1, GSTM1, GSTT1, GSTP1, MPO, MnSOD, eNOS, CAT) were determined from blood samples by MALDI-TOF. The associations between telangiectasia and genotypes were evaluated by multivariate unconditional logistic regression models. Patients with variant GSTA1 genotypes were at significantly increased risk of telangiectasia (OR 1.86, 95% CI 1.11-3.11). Reduced odds ratios of telangiectasia were noted for women with lower-activity eNOS genotype (OR 0.58, 95% CI 0.36-0.93). Genotype effects were modified by follow-up time, with the highest risk observed after 4 years of radiotherapy for gene polymorphisms in ROS-neutralizing enzymes. Decreased risk with eNOS polymorphisms was significant only among women with less than 4 years of follow-up. All other risk estimates were nonsignificant. Late effects of radiation therapy on skin appear to be modified by variants in genes related to protection from oxidative stress. The application of genomics to outcomes following radiation therapy holds the promise of radiation dose adjustment to improve both cosmetic outcomes and quality of life for breast cancer patients. ' 2007 Wiley-Liss, Inc.Key words: genetic polymorphisms; reactive oxygen species; longterm toxicities; radiation therapy; breast cancer Lumpectomy followed by radiation therapy is an effective treatment for women with early-stage breast cancer and is offered for the purpose of breast conservation and better cosmetic results. 1With recent advances in radiation techniques and computer tomography (CT) dose planning, it is possible to reduce cardiac toxicity due to radiotherapy; however, skin reactions, pain, breast edema and poor cosmetic results remain as health concerns of treated breast cancer patients over time. 2,3 Because of the differences in physiological response of various skin layers to radiation, telangiectasia and subcutaneous fibrosis are among the most common long-term skin side effects of radiation therapy, with higher grade correlated with poor cosmesis. 4 The process of endothelium reconstruction is radiation dosedependent, progresses over months and years and leads to the increase in severity of both telangiectasia and fibrosis.5-7 Besides duration, radiation dose and schedule, 8,9 and other factors such as radiation fields, type of surgery, increased breast size, tamoxifen treatment, chemotherapy, acute skin reactions, age, race...

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Factors influencing cosmetic results after breast conserving management (Turkish experience)

Cited by 21 publications

References 29 publications

Determinants for patient satisfaction regarding aesthetic outcome and skin sensitivity after breast-conserving surgery

Determinants for patient satisfaction regarding aesthetic outcome and skin sensitivity after breast-conserving surgery

Genetic polymorphisms in DNA repair and damage response genes and late normal tissue complications of radiotherapy for breast cancer

Genetic predictors of long‐term toxicities after radiation therapy for breast cancer

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