title: The influence of the boost in breast-conserving therapy on cosmetic outcome in the EORTC "boost versus no boost" trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups. European Organization for Research and Treatment of Cancer.
abstract: OBJECTIVE
  To evaluate the influence of a radiotherapy boost on the cosmetic outcome after 3 years of follow-up in patients treated with breast-conserving therapy (BCT).
  
  
  METHODS
  In EORTC trial 22881/10882, 5569 Stage I and II breast cancer patients were treated with tumorectomy and axillary dissection, followed by tangential irradiation of the breast to a dose of 50 Gy in 5 weeks, at 2 Gy per fraction. Patients having a microscopically complete tumor excision were randomized between no boost and a boost of 16 Gy. The cosmetic outcome was evaluated by a panel, scoring photographs of 731 patients taken soon after surgery and 3 years later, and by digitizer measurements, measuring the displacement of the nipple of 3000 patients postoperatively and of 1141 patients 3 years later.
  
  
  RESULTS
  There was no difference in the cosmetic outcome between the two treatment arms after surgery, before the start of radiotherapy. At 3-year follow-up, both the panel evaluation and the digitizer measurements showed that the boost had a significant adverse effect on the cosmetic result. The panel evaluation at 3 years showed that 86% of patients in the no-boost group had an excellent or good global result, compared to 71% of patients in the boost group (p = 0.0001). The digitizer measurements at 3 years showed a relative breast retraction assessment (pBRA) of 7.6 pBRA in the no-boost group, compared to 8.3 pBRA in the boost group, indicating a worse cosmetic result in the boost group at follow-up (p = 0.04).
  
  
  CONCLUSIONS
  These results showed that a boost dose of 16 Gy had a negative, but limited, impact on the cosmetic outcome after 3 years.
authors.affiliation: Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam.
authors.forename: C
authors.initials: C
authors.lastname: Vrieling
authors.forename: L
authors.initials: L
authors.lastname: Collette
authors.forename: A
authors.initials: A
authors.lastname: Fourquet
authors.forename: W J
authors.initials: WJ
authors.lastname: Hoogenraad
authors.forename: J C
authors.initials: JC
authors.lastname: Horiot
authors.forename: J J
authors.initials: JJ
authors.lastname: Jager
authors.forename: M
authors.initials: M
authors.lastname: Pierart
authors.forename: P M
authors.initials: PM
authors.lastname: Poortmans
authors.forename: H
authors.initials: H
authors.lastname: Struikmans
authors.forename: M
authors.initials: M
authors.lastname: Van der Hulst
authors.forename: E
authors.initials: E
authors.lastname: Van der Schueren
authors.forename: H
authors.initials: H
authors.lastname: Bartelink
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000033:anatomy & histology / Q000473:pathology / Q000528:radiation effects; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D015588:Observer Variation; D011879:Radiotherapy Dosage