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Objective assessment of cosmetic outcome after targeted intraoperative radiotherapy in breast cancer: results from a randomised controlled trial

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Abstract

The international randomised targeted intraoperative radiotherapy (TARGIT) trial has demonstrated evidence of non-inferiority between the novel technique of TARGIT (intra-operative radiotherapy with Intrabeam®) and conventional external beam radiotherapy (EBRT) in women with early breast cancer in terms of the primary outcome measure of risk of local relapse within the treated breast. Cosmesis is an increasingly important outcome of breast conserving treatment with both surgery and radiotherapy contributing to this. It was unknown if the single high dose of TARGIT may lead to damaging fibrosis and thus impair cosmesis further, so we objectively evaluated the aesthetic outcome of patients within the TARGIT randomised controlled trial. We have used an objective assessment tool for evaluation of cosmetic outcome. Frontal digital photographs were taken at baseline (before TARGIT or EBRT) and yearly thereafter for up to 5 years. The photographs were analysed by BCCT.core, a validated software which produces a composite score based on symmetry, colour and scar. 342 patients were assessed, median age at baseline 64 years (IQR 59–68). The scores were dichotomised into Excellent and Good (EG), and Fair and Poor (FP). There were statistically significant increases in the odds of having an outcome of EG for patients in the TARGIT group relative to the EBRT group at year 1 (OR 2.07, 95 % CI 1.12–3.85, p = 0.021) and year 2 (OR 2.11, 95 % CI 1.0–4.45, p = 0.05). Following a totally objective assessment in a randomised setting, the aesthetic outcome of patients demonstrates that those treated with TARGIT have a superior cosmetic result to those patients who received conventional external beam radiotherapy.

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References

  1. Forouzanfar MH, Foreman KJ, Delossantos AM et al (2011) Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. Lancet 378:1461–1484

    Article  PubMed  Google Scholar 

  2. Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232

    Article  PubMed  Google Scholar 

  3. Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241

    Article  PubMed  Google Scholar 

  4. Vaidya JS, Joseph DJ, Tobias JS et al (2010) Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT—a trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 376:91–102

    Article  PubMed  Google Scholar 

  5. Siegel R, Desantis C, Virgo K et al (2012) Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin 62:220–241

    Article  PubMed  Google Scholar 

  6. Kurtz J (1995) Impact of radiotherapy on breast cosmesis. Breast 4:163–169

    Article  Google Scholar 

  7. Pezner RD, Patterson MP, Hill LR et al (1985) Breast retraction assessment: an objective evaluation of cosmetic results of patients treated conservatively for breast cancer. Int J Radiat Oncol Biol Phys 11:575–578

    Article  PubMed  CAS  Google Scholar 

  8. Harris JR, Levene MB, Svensson G, Hellman S (1979) Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys 5:257–261

    Article  PubMed  CAS  Google Scholar 

  9. Fitzal F, Krois W, Trischler H et al (2007) The use of a breast symmetry index for objective evaluation of breast cosmesis. Breast 16:429–435

    Article  PubMed  CAS  Google Scholar 

  10. Cardoso MJ, Cardoso J, Amaral N et al (2007) Turning subjective into objective: the BCCT.core software for evaluation of cosmetic results in breast cancer conservative treatment. Breast 16:456–461

    Article  PubMed  Google Scholar 

  11. Cardoso JS, Cardoso MJ (2007) Towards an intelligent medical system for the aesthetic evaluation of breast cancer conservative treatment. Artif Intell Med 40:115–126

    Article  PubMed  Google Scholar 

  12. Taylor ME, Perez CA, Halverson KJ et al (1995) Factors influencing cosmetic results after conservation therapy for breast cancer. Int J Radiat Oncol Biol Phys 31:753–764

    Article  PubMed  CAS  Google Scholar 

  13. Oliveira HP, Magalhaes A, Cardoso MJ, Cardoso JS (2010) An accurate and interpretable model for BCCT.core. Conf Proc IEEE Eng Med Biol Soc 2010:6158–6161

    PubMed  Google Scholar 

  14. Cardoso MJ, Magalhaes A, Almeida T et al (2008) Is face-only photographic view enough for the aesthetic evaluation of breast cancer conservative treatment? Breast Cancer Res Treat 112:565–568

    Article  PubMed  Google Scholar 

  15. Cardoso MJ, Cardoso JS, Wild T, Krois W, Fitzal F (2009) Comparing two objective methods for the aesthetic evaluation of breast cancer conservative treatment. Breast Cancer Res Treat 116:149–152

    Article  PubMed  Google Scholar 

  16. Barnett GC, Wilkinson JS, Moody AM et al (2011) Randomized controlled trial of forward-planned intensity-modulated radiotherapy for early breast cancer: interim results at 2 years. Int J Radiat Oncol Biol Phys 82:715–723

    Article  PubMed  Google Scholar 

  17. Ivanov O, Dickler A, Lum BY, Pellicane JV, Francescatti DS (2011) Twelve-month follow-up results of a trial utilizing Axxent electronic brachytherapy to deliver intraoperative radiation therapy for early-stage breast cancer. Ann Surg Oncol 18:453–458

    Article  PubMed  Google Scholar 

  18. Lemanski C, Azria D, Gourgon-Bourgade S et al (2010) Intraoperative radiotherapy in early-stage breast cancer: results of the Montpellier phase II trial. Int J Radiat Oncol Biol Phys 76:698–703

    Article  PubMed  Google Scholar 

  19. Haley M, Beriwal S, Heron DE et al (2009) MammoSite accelerated partial breast irradiation: a single-institution outcomes analysis with 2 years of follow up. Brachytherapy 8:9–13

    Article  PubMed  Google Scholar 

  20. Sacchini V, Beal K, Goldberg J, Montgomery L, Port E, McCormick B (2008) Study of quadrant high-dose intraoperative radiation therapy for early-stage breast cancer. Br J Surg 95:1105–1110

    Article  PubMed  CAS  Google Scholar 

  21. Munshi A, Kakkar S, Bhutani R, Jalali R, Budrukkar A, Dinshaw KA (2009) Factors influencing cosmetic outcome in breast conservation. Clin Oncol (R Coll Radiol) 21:285–293

    Article  CAS  Google Scholar 

  22. Eaton DJ, Best B, Brew-Graves C et al (2012) In vivo dosimetry for single-fractiontargeted intraoperative radiotherapy (TARGIT) for breast cancer. Int J Radiat Oncol Biol Phys 82:e819–e824

    Article  PubMed  Google Scholar 

  23. Olivotto IA, Whelan TJ, Parpia S, Kim DH, Berrang T, Truong PT, Kong I, Cochrane B, Nichol A, Roy I, Germain I, Akra M, Reed M, Fyles A, Trotter T, Perera F, Beckham W, Levine MN, Julian JA (2013) Interim cosmetic and toxicity results from RAPID: a randomized trial of accelerated partial breast irradiation using three-dimensional conformal external beam radiation therapy. J Clin Oncol. doi:10.1200/JCO.2013.50.5511

  24. Losken A, Fishman I, Denson DD, Moyer HR, Carlson GW (2005) An objective evaluation of breast symmetry and shape differences using 3-dimensional images. Ann Plast Surg 55:571–575

    Article  PubMed  CAS  Google Scholar 

  25. Catanuto G, Spano A, Pennati A, Nava M (2009) Three-dimensional digital evaluation of breast symmetry after breast conservation therapy. J Am Coll Surg 208:166

    Article  PubMed  Google Scholar 

  26. Moyer HR, Carlson GW, Styblo TM, Losken A (2008) Three dimensional digital evaluation of breast symmetry after breast conservation therapy. J Am Coll Surg 207:227–232

    Article  PubMed  Google Scholar 

  27. Cardoso MJ, Cardoso JS, Vrieling C et al (2012) Recommendations for the aesthetic evaluation of breast cancer conservative treatment. Breast Cancer Res Treat 135:629–637

    Article  PubMed  Google Scholar 

  28. Sperk E, Welzel G, Keller A et al (2012) Late radiation toxicity after intraoperative radiotherapy (IORT) for breast cancer: results from the randomized phase III trial TARGIT A. Breast Cancer Res Treat 135:253–260

    Article  PubMed  Google Scholar 

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Acknowledgments

The main TARGIT A Trial is funded by the HTA (project ref 07/60/49) ISRCTN34086741 and sites in Australia were funded by a project grant awarded by the National Health and Medical Research Council. The authors thank the TARGIT Trialists’ Group for the TARGIT A Trial.

Conflict of interest

Carl Zeiss (the manufacturer of the Intrabeam system) covers travelling expenses for meetings of the TARGIT Trial International Steering Committee and conferences where a presentation about Targeted Intraoperative Radiotherapy is being made.

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Authors and Affiliations

  1. Department of Surgery, Royal Free London NHS Foundation Trust, University College London, Pond Street, London, NW3 2QG, UK

    Mohammed R. S. Keshtgar & Nikolaos V. Michalopoulos

  2. Clinical Trials Group, Centre for Clinical Science and Technology, UCL Medical School, Clerkenwell Building, Archway Campus, Highgate Hill, London, N19 5LW, UK

    Norman R. Williams

  3. Institute of Health and Rehabilitation Research, University of Notre Dame, 19 Mouat Street, P.O. Box 1225, Fremantle, WA, 6959, Australia

    Max Bulsara

  4. School of Surgery, QEII Medical Centre, Perth, WA, 6009, Australia

    Christobel Saunders

  5. Department of Surgery, Herlev Hospital, University of Copenhagen, 2730, Herlev, Denmark

    Henrik Flyger & Neils Bentzon

  6. INESC TEC and Faculty of Engineering, University of Porto, Porto, Portugal

    Jaime S. Cardoso

  7. Radiation Oncology, Sir Charles Gairdner Hospital, Nerdland, WA, Australia

    Tammy Corica

  8. Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia

    David J. Joseph

Authors
  1. Mohammed R. S. Keshtgar
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  2. Norman R. Williams
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  3. Max Bulsara
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  4. Christobel Saunders
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  5. Henrik Flyger
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  6. Jaime S. Cardoso
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  7. Tammy Corica
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  8. Neils Bentzon
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  9. Nikolaos V. Michalopoulos
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  10. David J. Joseph
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Corresponding author

Correspondence to Mohammed R. S. Keshtgar.

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Keshtgar, M.R.S., Williams, N.R., Bulsara, M. et al. Objective assessment of cosmetic outcome after targeted intraoperative radiotherapy in breast cancer: results from a randomised controlled trial. Breast Cancer Res Treat 140, 519–525 (2013). https://doi.org/10.1007/s10549-013-2641-8

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  • DOI: https://doi.org/10.1007/s10549-013-2641-8

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