title: Therapeutic factors influencing the cosmetic outcome and late complications in the conservative management of early breast cancer.
abstract: OBJECTIVE
  To investigate the impact of clinical and physical parameters on the cosmetic result and complications, in cancer breast treated with conservative surgery and definitive irradiation.
  
  
  METHODS
  Between October 1980 and December 1990, 289 patients were treated with lumpectomy and/or axillary dissection, radical irradiation with or without adjuvant therapy. The radiation therapy technique consisted of external beam therapy followed by an Ir-192 implant or electron beam boost. Univariate and multivariate analysis were used to evaluate the correlation between multiple factors affecting the cosmetic outcome and the complications.
  
  
  RESULTS
  Of 289 patients, cosmesis was evaluable in 285 and recorded as excellent to good in 226 (79%), fair in 35 (12%), and poor in 24 (9%). On multivariate analysis of these results, a high dose per fraction (p = .0018), and use of electrons as boost to the tumor bed (p = .001) were found to be significant. When patients boosted with electrons were excluded, a high boost dose (p = .0433) was also found significant. Fifteen (5%) patients developed severe late radiation sequelae and 14 (5%) moderate or severe arm edema. On multivariate analysis only dose per fraction of 2.5 Gy (p < .0001) and higher boost doses (p = .017) were significant.
  
  
  CONCLUSIONS
  In 289 patients of early breast cancer treated with conservative surgery and radical irradiation, multivariate analysis suggests that higher dose per fraction with teletherapy and higher brachytherapy boost dose adversely affect cosmesis and contribute to the late complications.
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Parel, Bombay, India.
authors.forename: R
authors.initials: R
authors.lastname: Sarin
authors.forename: K A
authors.initials: KA
authors.lastname: Dinshaw
authors.forename: S K
authors.initials: SK
authors.lastname: Shrivastava
authors.forename: V
authors.initials: V
authors.lastname: Sharma
authors.forename: S M
authors.initials: SM
authors.lastname: Deore
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D004954:Esthetics; D005260:Female; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008197:Lymph Node Excision; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D011832:Radiation Injuries / Q000473:pathology; D011859:Radiography; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D016896:Treatment Outcome
chemical_list: D007496:Iridium Radioisotopes