Factors predicting Cosmesis (CA), Late effects (LE) and Patient reported outcome measures (PROM) in high-risk breast cancer (BC) treated with hypo-fractionated radiotherapy (HF-WBI): real world outcomes from a developing country

Abstract

Introduction: Literature on cosmesis in large operable (LO) and locally advanced breast cancer (LABC) is sparse, so we investigated the cosmesis, LE and PROM and factors affecting it in this subset. Materials and Methods: BC with upfront BCS or after neoadjuvant chemotherapy (NACT) underwent physical CA, LE and PROM using EORTC, RTOG and BR23 questionnaire respectively. Patient, tumour and treatment related factors were correlated with CA, LE and PROM by univariate and multivariate analysis. Results: 186 women underwent BCS, but only 82 could participate due to Covid. Prevalence of high-risk features were found: >3cm tumour in 37%, 50% node positive, 100% received CT, grade 3 in 57%, Her-2/TNBC in 70%. At a median follow-up of 5 years, we found that 56% patients had adverse global cosmesis. Factors responsible for adverse cosmesis were tumour size [> 3 cm, HR 2.3], node positivity [HR 0.3], receipt of CT [HR 6.5], large resection volumes [HR 4.6], large breast volume [HR 1], supraclavicular RT in 43% [HR 0.7]. Dosimetric factors found significant for adverse cosmesis were breast volume receiving 107% dose (> than 10cc, HR 5) and breast volume receiving 100% dose (> than 120cc, HR 5). The incidence of arm oedema was 6%, shoulder stiffness 20%, brachial plexopathy 4% and factors significant for LE were tumour size > 3cm [HR 9], breast volume receiving 107% [HR 6], and co-morbidity [HR 3]. 69% had poor body image, 35% breast pain, 47% were sexually active. Conclusion: BC with LO/LABC and high-risk features had adverse cosmesis in 56% women.