Simultaneous integrated boost irradiation after breast-conserving surgery: physician-rated toxicity and cosmetic outcome at 30 months' follow-up

E.J. Bantema-Joppe, C. Schilstra, G.H. de Bock, W.V. Dolsma, D.M. Busz, J.A. Langendijk, J.H. Maduro*

*Corresponding author for this work

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Abstract

PURPOSE: To evaluate toxicity and cosmetic outcome (CO) in breast cancer survivors treated with three-dimensional conformal radiotherapy with a hypofractionated, simultaneous integrated boost (3D-CRT-SIB) and to identify risk factors for toxicity, with special focus on the impact of age.

METHODS AND MATERIALS: Included were 940 consecutive disease-free patients treated for breast cancer (Stage 0-III) with 3D-CRT-SIB, after breast-conserving surgery, from 2005 to 2010. Physician-rated toxicity (Common Terminology Criteria for Adverse Events version 3.0) and CO were prospectively assessed during yearly follow-up, up to 5 years after radiotherapy. Multivariate logistic regression analyses using a bootstrapping method were performed.

RESULTS: At 3 years, toxicity scores of 436 patients were available. Grade ≥ 2 fibrosis in the boost area was observed in 8.5%, non-boost fibrosis in 49.4%, pain to the chest wall in 6.7%, and fair/poor CO in 39.7% of cases. Radiotherapy before chemotherapy was significantly associated with grade ≥ 2 boost fibrosis at 3 years (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.3-6.0). Non-boost fibrosis was associated with re-resection (OR 2.2, 95% CI 1.2-4.0) and larger tumors (OR 1.1, 95% CI 1.0-1.1). At 1 year, chest wall pain was significantly associated with high boost dosage (OR 2.1, 95% CI 1.2-3.7) and younger age (OR 0.4, 95% CI 0.2-0.7). A fair/poor CO was observed more often after re-resection (OR 4.5, 95% CI 2.4-8.5), after regional radiotherapy (OR 2.9, 95% CI 1.2-7.1), and in larger tumors (OR 1.1, 95% CI 1.0-1.1).

CONCLUSIONS: Toxicity and CO are not impaired after 3D-CRT-SIB. Fibrosis was not significantly associated with radiotherapy parameters. Independent risk factors for fibrosis were chemotherapy after radiotherapy, re-resection, and larger tumor size. Re-resection was most predictive for worse CO. Age had an impact on chest wall pain occurrence.

Original languageEnglish
Pages (from-to)E471-E477
JournalInternational Journal of Radiation Oncology Biology Physics
Volume83
Issue number4
DOIs
Publication statusPublished - 15-Jul-2012
Event29th Annual Meeting of the European-Society-for-Therapeutic-Radiology-and-Oncology (ESTRO) - , Spain
Duration: 12-Sep-201016-Sep-2010

Keywords

  • Toxicity
  • Cosmetic outcome
  • Breast cancer
  • Radiotherapy
  • NO BOOST
  • RANDOMIZED-TRIAL
  • LOCAL-CONTROL
  • EORTC BOOST
  • CANCER
  • THERAPY
  • RADIOTHERAPY
  • SURVIVAL
  • CONSERVATION

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