Orhan YALÇIN, Özge KANDEMİR, Semra GÜNAY, Arzu AKAN, Hakan TEZER

Effect of the Order of Adjuvant Treatment on the Cosmetic Results of Patients with Breast Cancer Treated with Breast- Conserving Surgery and Intraoperative Boost Radiotherapy

OBJECTIVEThe aim of this study was to investigate the cosmetic outcome of adjuvant treatment after breast conservingsurgery (BCS) and intraoperative boost radiotherapy (IOBRT) performed at the clinic over a4-year period.METHODSA total of 65 patients who underwent at least 1 year of treatment for a diagnosis of early stage breastcancer were included in the study. Whole breast irradiation cases were included in Group A (n=34), andpatients who underwent chemotherapy followed by WBI comprised Group B (n=31). Various details,including cosmetic outcome and score according to Johansen’s scoring system were evaluated at postoperativemonth 1, after first treatment, and at the conclusion of 1 year of treatment.RESULTSThe mean age of the patients was 53.5 years (range: 38-74 years), and the mean follow-up period was 23months (range: 12-39 months). The mean tumor diameter was 16.95 mm (range: 4-30 mm). The tumorwas located in the upper outer quadrant in 36 patients. It was determined that 14 patients had a comorbiddisease, 7 were premenopausal, 7 were cigarette smokers, 7 had a tumor of >2 cm and 11 had innerquadrant localization. In 15 cases, the score was 9 or greater, indicating a poor cosmetic result. There were7 patients with a poor cosmetic result in Group A, with a mean score of 10, and 8 patients from groupB, with a mean score of 10.3. An independent t-test did not reveal a statistically significant differencebetween the groups (p>0.1).CONCLUSIONThe effects of radiotherapy and chemotherapy in addition to BCS and IOBRT in early breast cancer caseswere similar with respect to cosmetic results. Smoking, comorbid disease, the size of the tumor and quadrantof localization may contribute to poor cosmetic outcome.

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Johansen J, Overgaard J, Rose C, Engelholm SA, Gadeberg CC, Kjaer M, et al. Cancer Cooperative Group (DBCG) and the DBCG Radiotherapy Committee. Cosmetic outcome and breast morbidity in breastconserving treatment--results from the Danish DBCG- 82TM national randomized trial in breast cancer. Acta Oncol 2002;41(4):369–80.
Forouzanfar MH, Foreman KJ, Delossantos AM, Lozano R, Lopez AD, Murray CJ, et al. Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. Lancet 2011;378(9801):1461–84.
Reitsamer R, Peintinger F, Kopp M, Menzel C, Kogelnik HD, Sedlmayer F. Local recurrence rates in breast cancer patients treated with intraoperative electron-boost radiotherapy versus postoperative external-beam electron- boost irradiation. A sequential intervention study. Strahlenther Onkol 2004;180(1):38–44.
Johansen J, Overgaard J, Overgaard M. Effect of adjuvant systemic treatment on cosmetic outcome and late normal-tissue reactions after breast conservation. Acta Oncol 2007;46(4):525–33.
Recht A. Integration of systemic therapy and radiation therapy for patients with early-stage breast cancer treated with conservative surgery. Clin Breast Cancer 2003;4(2):104–13.
Kimple RJ, Klauber-DeMore N, Kuzmiak CM, Pavic D, Lian J, Livasy CA, et al. Cosmetic outcomes for accelerated partial breast irradiation before surgical excision of early-stage breast cancer using single-dose intraoperative radiotherapy. Int J Radiat Oncol Biol Phys 2011;79(2):400–7.
Kelemen G, Varga Z, Lázár G, Thurzó L, Kahán Z. Cosmetic outcome 1-5 years after breast conservative surgery, irradiation and systemic therapy. Pathol Oncol Res 2012;18(2):421–7.
Günay S, Alan Ö, Yalçın O, Türkmen A, Dizdar N. Our intraoperative boost radiotherapy experience and applications. Ulus Cerrahi Derg 2015;32(1):30–6.
Sedlmayer F, Reitsamer R, Wenz F, Sperk E, Fussl C, Kaiser J, et al. Intraoperative radiotherapy (IORT) as boost in breast cancer. Radiat Oncol 2017;12(1):23.
Juneja P, Bonora M, Haviland JS, Harris E, Evans P, Somaiah N. Does breast composition influence late adverse effects in breast radiotherapy? Breast 2016;26:25- 30.
Eldredge-Hindy HB, Rosenberg AL, Simone NL. Intraoperative radiotherapy for breast cancer: the lasting effects of a fleeting treatment. Int J Breast Cancer 2014;2014:214325.
Urbanski B, Roszak A, Bratos K, Milecki P, Karczewska- Dzionk A, Litoborski M, et al. EP-1150: Patient quality of life treated with IORT during BCS followed by whole breast radiotherapy (WBI). Radiother Oncol 2016;19(Suppl 1):S549.
Vass S, Bairati I. A cosmetic evaluation of breast cancer treatment: a randomized study of radiotherapy boost technique. Int J Radiat Oncol Biol Phys 2005;62(5):1274–82.
Yu W, Lin Z, Ju ZJ, Li XR, Zhang YJ, Kong QL, et al. Intraoperative radiation therapy delivered prior to lumpectomy for early-stage breast cancer: a single institution study. Am J Cancer Res 2015;5(7):2249–57.