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Patient-reported Long-term Cosmetic Outcomes Following Short Fractionation Whole Breast Radiotherapy With Boost

Chan, Elisa K. MD; Tabarsi, Nazlee BSc; Tyldesley, Scott MD; Khan, Mohamed MD; Woods, Ryan MSc; Speers, Caroline BA; Weir, Lorna MD

American Journal of Clinical Oncology: October 2016 - Volume 39 - Issue 5 - p 473–478
doi: 10.1097/COC.0000000000000084
Original Articles: Breast

Objectives: To evaluate the cosmetic effect of a tumor-bed boost after hypofractionated whole breast irradiation (HF-WBI+B) using a patient-reported questionnaire.

Materials and Methods: Between 2000 and 2005, 4392 women aged 75 years and younger with unilateral early-stage breast cancer received HF-WBI alone or HF-WBI+B. From each group, 800 randomly sampled surviving and nonrelapsed women were invited to complete the Breast Cancer Treatment Outcomes Scale questionnaire.

Results: A total of 312 women completed the questionnaire: 154 received HF-WBI alone and 158 received HF-WBI+B. Median ages of respondents were 57 years for HF-WBI alone and 52 years for HF-WBI+B (P<0.001). Women receiving HF-WBI+B had a shorter follow-up interval, higher T stage, higher grade, and were more likely to have had nodal radiotherapy and chemotherapy. There were similar responses comparing the overall appearance of the treated to untreated breast (42% stating no or slight difference for HF-WBI alone vs. 41% for HF-WBI+B, P=0.87). The HF-WBI+B group was: (a) slightly worse on the cosmetic subscale (2.3 vs. 2.1, P=0.02); (b) worse on the pain subscale (2.0 vs. 1.6, P<0.0001); but (c) better on the functional subscale (1.5 vs. 1.8, P<0.001). When the pain subscale was applied to the area around the scar (a surrogate for the tumor-bed), the 2 groups were similar (2.0 vs. 2.0, P=0.71).

Conclusions: Similar to conventional fractionated whole breast radiotherapy with a tumor-bed boost, women who received short fractionation whole breast radiotherapy with boost self-report only slightly worse long-term cosmetic and pain outcomes compared with women who received short fractionation alone.

*Department of Oncology, Saint John Regional Hospital, Saint John, NB

Faculty of Medicine, University of British Columbia

Department of Radiation Oncology

§Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver Centre, Vancouver, BC, Canada

Presented at the 26th Annual Scientific meeting of the Canadian Association of Radiation Oncology, Ottawa, ON, Canada, September 12 to 15, 2012 and at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium, San Antonio, TX, December 4 to 8, 2012.

S.T. is supported by the Michael Smith Foundation for Health Research. E.C. is supported by the Canadian Breast Cancer Foundation, BC/Yukon Division.

The authors declare no conflicts of interest.

Reprints: Lorna Weir, MD, Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver Centre, 600 West 10th Ave, Vancouver, BC, Canada V5Z 4E6. E-mail:

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