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Single dose IOERT versus whole breast irradiation

Cosmetic results in breast-conserving therapy

Alleinige IOERT versus Ganzbrustbestrahlung

Kosmetische Ergebnisse bei der brusterhaltenden Therapie

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Abstract

Background

Scarce data are available about the cosmetic result of single dose intraoperative electron radiotherapy (IOERT) in breast-conserving radiotherapy.

Methods and materials

We included 71 breast cancer patients. Breast-conserving surgery and sentinel node procedure had started almost 3 years earlier. Subsequently, 26 patients were treated with IOERT and 45 patients received postoperative whole breast irradiation (WBI). For both groups we determined seven dimensionless asymmetry features. We compared the subjectively and the objectively derived cosmetic scores with each other.

Results

For four asymmetry features we noted significantly smaller differences for patients treated with IOERT when compared to those treated with WBI: relative breast contour difference, relative breast area difference and relative breast overlap difference. After correcting for excision volume a significant difference was noticed also for relative lower breast contour. For the IOERT group the cosmetic scores “excellent or good” as determined by each patient and one physician were 88 and 96 %, respectively. When the overall cosmetic scores for patients treated with IOERT and WBI were compared to those of the objectively derived scores, there was a fair level of agreement.

Conclusion

For patients treated with IOERT we noted less asymmetry and high rates of “good or excellent” subjectively derived cosmetic scores. The level of agreement between the subjectively and the objectively derived cosmetic scores was limited. Due to the small sample size and the design of the study no definitive conclusions can be drawn.

Zusammenfassung

Hintergrund

Es sind nur wenige Daten zum kosmetischen Ergebnis nach alleiniger intraoperativer Radiotherapie mittels Elektronen (IOERT) in der brusterhaltenden Behandlung verfügbar.

Methoden und Materialien

In einer komparativen Kohortenanalyse wurden 71 Brustkrebspatientinnen eingeschlossen. Ihre brusterhaltende Operation mit Sentinel-Lymphknotenverfahren begann 3 Jahre vorher. Im Anschluss erhielten 26 Patientinnen zusätzlich eine IOERT und 45 Patientinnen eine postoperative Ganzbrustbestrahlung (WBI). Wir verglichen die Unterschiede von 7 dimensionslosen Asymmetriemerkmalen zwischen beiden Gruppen sowie subjektiv und objektiv ermittelte kosmetische Werte.

Ergebnisse

Die folgenden vier dimensionslosen Asymmetriemerkmale waren in der IOERT-Gruppe im Vergleich zur WBI-Kohorte signifikant besser: relative Brustkonturlängendifferenz, Differenz der relativen Brustfläche und relativer Brustüberlappungsunterschied. Auch in der relativen kaudalen Brustkontur wurde nach Korrektur für die Exzisionsvolumina ein signifikanter Unterschied verzeichnet. Die kosmetischen Ergebnisse der IOERT-Gruppe wurden von den Patientinnen bzw. einem Arzt in 88 % bzw. 96 % der Fälle als „ausgezeichnet oder gut“ gewertet. Die kosmetischen Gesamt-Scores der IOERT- und WBI-Gruppe zeigten eine begrenzte Übereinstimmung mit den objektiv bestimmten kosmetischen Scores.

Schlussfolgerung

Für die IOERT-Gruppe wurden geringere Asymmetrieraten festgestellt sowie hohe Raten von subjektiven Bewertungen mit „ausgezeichnet oder gut“. Die Übereinstimmung zwischen subjektiv und objektiv bestimmten Werten war begrenzt. Aufgrund der kleinen Anzahl von Patientinnen und des Studiendesigns können keine endgültigen Schlussfolgerungen gezogen werden.

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Authors and Affiliations

  1. Radiotherapy Centre West, Medical Centre Haaglanden, Lijnbaan 32, 2501 CK, The Hague, The Netherlands

    Henk Struikmans, Malou Snijders, Mirjam E. Mast, Ursula Fisscher, Anna Petoukhova & Peter Koper

  2. Department of Radiotherapy, HAGA Medical Centre, Leyweg 275, 2545 CH, The Hague, The Netherlands

    Jan-Huib Franssen & Gabrielle Speijer

  3. Department of Radiotherapy, Reinier de Graaf Medical Centre, Reinier de Graafweg 3/11, 2625 AD, Delft, The Netherlands

    Marcelle J. Immink

  4. Department of Surgery, Medical Centre Haaglanden, Lijnbaan 32, 2501 CK, The Hague, The Netherlands

    Andreas Marinelli

  5. Department of Surgery, HAGA Medical Centre, Leyweg 275, 2545 CH, The Hague, The Netherlands

    Jos Merkus

  6. Department of Radiotherapy, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands

    Henk Struikmans & Marcelle J. Immink

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  1. Henk Struikmans
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Correspondence to Henk Struikmans.

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Conflict of interest

H. Struikmans, M. Snijders, M.E. Mast, U. Fisscher, J.-H. Franssen, M.J. Immink, A. Marinelli, J Merkus, A. Petoukhova, G. Speijer and P. Koper state that they have no competing interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Struikmans, H., Snijders, M., Mast, M.E. et al. Single dose IOERT versus whole breast irradiation. Strahlenther Onkol 192, 705–713 (2016). https://doi.org/10.1007/s00066-016-1029-1

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  • DOI: https://doi.org/10.1007/s00066-016-1029-1

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