title: A comparison in cosmetic outcome between per-operative interstitial breast implants and delayed interstitial breast implants after external beam radiotherapy.
abstract: OBJECTIVE
  Interstitial implants for brachytherapy boost in the breast conserving therapy of breast cancer can be performed in two ways; implants during the tumor excision (per-operative implants) or after the external beam therapy (delayed interstitial implants). Differences in cosmetic outcome were investigated.
  
  
  METHODS
  Cosmetic results in 47 patients having a per-operative implant were compared to 123 patients having a delayed interstitial implant in a matched case-control study. Cosmesis was scored on a four-point-scale varying from 0 (excellent) to 3 (poor).
  
  
  RESULTS
  After mean follow-up of 63 months, three observers found no difference in cosmetic outcome between the two groups after adjustment for variables found to be related with cosmesis (difference in mean score 0.50, P=0.26). Implant volume at 100% isodose was not found to differ (P=0.084) between the per-operative group (mean 102 cm3, S.D. 34 cm3) and the delayed group (mean 93 cm3, S.D. 29 cm3).
  
  
  CONCLUSIONS
  Performing per-operative implants has not led to smaller implants. The method of performing brachytherapy does not result in marked differences in cosmetic outcome.
authors.affiliation: The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Pieters
authors.forename: Augustinus A M
authors.initials: AA
authors.lastname: Hart
authors.forename: Nicola S
authors.initials: NS
authors.lastname: Russell
authors.forename: Edwin P M
authors.initials: EP
authors.lastname: Jansen
authors.forename: Johannes L
authors.initials: JL
authors.lastname: Peterse
authors.forename: Jacques
authors.initials: J
authors.lastname: Borger
authors.forename: Emiel J Th
authors.initials: EJ
authors.lastname: Rutgers
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects; D001940:Breast / Q000528:radiation effects* / Q000601:surgery; D019928:Breast Implantation / Q000379:methods*; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D005355:Fibrosis / Q000209:etiology; D006801:Humans; D007430:Intraoperative Care; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome