Quantitative assessment of breast cosmetic outcome following whole breast irradiation

Publication date: Available online 21 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Jay P. Reddy, Xiudong Lei, Sheng-Cheng Huang, Krista M. Nicklaus, Michelle C. Fingeret, Simona F. Shaitelman, Kelly K. Hunt, Thomas A. Buchholz, Fatima Merchant, Mia K. Markey, Benjamin D. Smith
PurposeClinical studies of breast radiation therapy typically assess breast cosmetic outcome using subjective scales which may lack reproducibility or ability to discriminate subtle changes. To overcome these limitations, quantitative measures of breast cosmesis have been proposed, but their clinical relevance remains unproven. We applied quantitative analysis of digital photographs to measure breast cosmetic outcome within the setting of a randomized trial of conventionally fractionated (CF) and hypofractionated (HF) whole breast irradiation (WBI). Our goals were to identify how quantitative cosmesis metrics were associated with patient- and physician-reported cosmesis and whether they differed by treatment arm.Materials/MethodsFrom 2011-2014, 287 women age>40 with DCIS or early invasive breast cancer were randomized to HF-WBI (42.56Gy/16fx+10-12.5Gy/4-5fx boost) or CF-WBI (50Gy/25fx+10-14Gy/5-7fx). At one year post-treatment, we collected digital photographs, patient-reported cosmesis using the Breast Cancer Treatment and Outcomes Scale (BCTOS), and physician-reported cosmesis using the Radiation Therapy Oncology Group (RTOG) scale. Six quantitative measures of breast symmetry, labeled M1-M6, were calculated from anteroposterior digital photographs. For each measure, values closer to 1 imply greater symmetry, and values closer to 0 imply greater asymmetry. Associations between M1-M6 and patient- and physician-reported cosmesis and treatment arm were evaluated using the Kruskal-Wallis test.ResultsAmong 245 evaluable patients, patient-reported cosmesis was strongly associated with M1 (vertical symmetry measure) (P<0.01). Physician-reported cosmesis was similarly correlated with M1 (P<0.01) and also with M2 (vertical symmetry, P=0.01) and M4 (horizontal symmetry, P=0.03). At one-year post-treatment, HF-WBI resulted in better values of M2 (P=0.02) and M3 (P<0.01) than CF-WBI; treatment arm was not significantly associated with M1, M4, M5, or M6 (P≥0.12).ConclusionsQuantitative assessment of breast photographs reveals similar to improved cosmetic outcome with HF-WBI compared to CF-WBI one year after treatment. Assessing cosmetic outcome using these measures could be useful for future comparative effectiveness studies and outcome reporting.



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